The mechanical consequences of variation in the mineral content of bone

Estimating nanoscale deformation in bone by X-ray diffraction imaging method

Knowledge of internal stress-strain in bone tissue is important for clinical diagnosis and remedies. The inorganic mineral phase of apatite crystals in bone composite, because of its crystalline nature, provides a reliable way of measurement through X-ray diffraction system. Use of two-dimensional detector, imaging plate (IP), is considered to expedite the process with much more information, hence, is widely applied in the study of organization, stress, strain, etc. for crystalline substance. The distortion of Debye rings in the image obtained by IP can be directly related to the deformation in lattice plane of the crystals. Since X-ray diffraction method involves measurement at nano-level, proper focus on the extraction of data and corresponding analysis is needed. In the current work, we considered weighted average value of intensity to locate radius vectors along azimuthal direction in the diffracted rings from the primary array of digital data in steps of pixels. The widely applied approaches for profile shift measurement--peak shift and full width at half maximum (FWHM) of a peak, and shift of center of gravity of profile--were compared with a new concept of segmental shift (SS) proposed previously by the authors. We observed reliable and effective outcomes with higher precision in the consideration of SS while using IP as a detector. Our approach in this work for intensity integration and radius vector positioning especially add precision in such applications.

Multi-modality study of the compositional and mechanical implications of hypomineralization in a rabbit model of osteomalacia

Osteomalacia is characterized by hypomineralization of the bone associated with increased water content. In this work we evaluate the hypotheses that 1) 3D solid-state magnetic resonance imaging (MRI) of (31)P (SSI-PH) and (1)H (SSI-WATER) of cortical bone can quantify the key characteristics of osteomalacia induced by low-phosphate diet; and 2) return to normophosphatemic diet (NO) results in recovery of these indices to normal levels. Twenty female five-week old rabbits were divided into four groups. Five animals were fed a normal diet for 8 weeks (NOI); five a hypophosphatemic diet (0.09%) for the same period to induce osteomalacia (HYI). To examine the effect of recovery from hypophosphatemia an additional five animals received a hypophosphatemic diet for 8 weeks, after which they were returned to a normal diet for 6 weeks (HYII). Finally, five animals received a normal diet for the entire 14 weeks (NOII). The NOI and HYI animals were sacrificed after 8 weeks, the NOII and HYII groups after 14 weeks. Cortical bone was extracted from the left and right tibiae of all the animals. Water content was measured by SSI-WATER and by a previously reported spectroscopic proton-deuteron nuclear magnetic resonance (NMR) exchange technique (NMR-WATER), phosphorus content by SSI-PH. All MRI and NMR experiments were performed on a 9.4 T spectroscopy/micro-imaging system. Degree of mineralization of bone (DMB) was measured by micro-CT and elastic modulus and ultimate strength by 3-point bending. The following parameters were lower in the hypophosphatemic group: phosphorus content measured by SSI-PH (9.5+/-0.4 versus 11.1+/-0.3 wt.%, p<0.0001), ash content (63.9+/-1.7 versus 65.4+/-1.1 wt.%, p=0.05), ultimate strength, (96.3+/-16.0 versus 130.7+/-6.4 N/mm(2), p=0.001), and DMB (1115+/-28 versus 1176+/-24 mg/cm(3), p=0.003); SSI-WATER: 16.1+/-1.5 versus 14.4+/-1.1 wt.%, p=0.04; NMR-WATER: 19.0+/-0.6 versus 17.4+/-1.2 wt.%, p=0.01. Return to a normophosphatemic diet reduced or eliminated these differences (SSI-PH: 9.5+/-0.9 versus 10.6+/-0.8 wt.%, p=0.04; DMB: 1124+/-31 versus 1137+/-10 mg/cm(3), p=0.2; US: 95.6+/-18.6 versus 103.9+/-7.5 N/mm(2), p=0.2; SSI-WATER: 12.4+/-0.6 versus 12.2+/-0.3 wt.%, p=0.3) indicating recovery of the mineral density close to normal levels. Phosphorus content measured by SSI-PH was significantly correlated with DMB measured by micro-CT (r(2)=0.47, p=0.001) as well as with ultimate strength (r(2)=0.54, p=0.0004). The results show that the methods presented have potential for in situ assessment of mineralization and water, both critical to the bone's mechanical behavior.

Influence of interimplant distance on bone microstructure: a histomorphometric study in dogs

The microstructure of the crestal alveolar bone is important for both the maintenance of osseointegration and the location of the gingival soft tissues. The aim of this study was to evaluate and compare the bone microstructure of the alveolar bone and of the interimplant bone in implants inserted at different interimplant distances. The mandibular bilateral premolars of six dogs were extracted, and after 12 weeks, each dog received eight implants, for a total of 48 implants. Two pairs of implants, one for each hemiarch, were separated by 2 mm (group 1) and by 3 mm (group 2). After 12 weeks, the implants received temporary acrylic prostheses. After four more weeks, metallic crowns substituted the temporary prostheses. After an additional 8 weeks the animals were sacrificed and the hemimandibles were removed, dissected, and processed. The longitudinal collagen fiber orientation was 43.2% for the alveolar bone; it was 30.3% for the 2-mm group and 43.9% for the 3-mm group. There was a statistically significant difference between the 2-mm and 3-mm groups (p < .05). The orientation of transverse collagen fibers was 47.8% for the alveolar bone; it was 37.3% for the 2-mm group and 56.3% for the 3-mm group. There was a statistically significant difference between the 2-mm and 3-mm groups (p < .05). The marrow spaces were 34.87% for the alveolar bone, 52.3% for the 2-mm group, and 59.9% for the 3-mm group. There was a statistically significant difference between the alveolar bone and the 3-mm group (p < .05). The low mineral density index was 36.29 for the alveolar bone, 46.76 for the 2-mm group, and 17.91 for the 3-mm group. There was a statistically significant difference between the 2-mm and 3-mm groups (p < .05). The high mineral density was 87.57 for the alveolar bone, 72.58 for the 2-mm group, and 84.91 for the 3-mm group. There was a statistically significant difference between the alveolar bone and the 2-mm group (p < .05). The collagen fiber orientation resulted in statistically significant differences in both the 2-mm and 3-mm groups compared with the alveolar bone. The marrow spaces appeared significantly increased in the 3-mm group compared with the alveolar bone. The low mineral density index was significantly higher in the 2-mm group, while the high mineral density index was significantly higher in the alveolar bone. In conclusion, the interimplant distance should not be less than 3 mm.

Uniform partial dissolution of bone mineral by using fluoride and phosphate ions combination

Mineral content is one of the main predictors of the mechanical properties of bone tissue. The contribution of the bone mineral phase to the mechanical properties of bone has been investigated by reducing the mineral content of bone with different in vitro treatment techniques such as hydrochloric acid (HCl), ethylenedinitrilo tetraacetic acid (EDTA), and fluoride ion treatment. In this study, we propose a new treatment technique which combines fluoride and phosphate ions. Bovine femur specimens were used to determine the mechanical properties of cortical bone after different fluoride phosphate ion combination treatments. The treatment solutions, which contain different fluoride and phosphate ion concentrations, dissolved part of the bone mineral in a uniform manner throughout the bone samples. Dissolution by products, which precipitated in the bone tissue, contained calcium fluoride with phosphate ions (CaF(2)/P) and fluorapatite/fluorhydroxyapatite-type material (FAp/FHAp) and acted as filler. Depending on the fluoride and phosphate concentration in a treatment solution, the precipitated material's ratio of FAp/FHAp to total fluoride containing phase (FAp/FHAp + CaF(2)/P) in bone tissue also changed. High fluoride ion content in treatment solutions generated more CaF(2)/P type of precipitate, and low fluoride ion concentration generated more FAp/FHAp type precipitates as compared to high fluoride concentration treatments. These experiments show that phosphate ions are another important parameter of a treatment solution, in addition to ionic strength, pH, and the duration of treatment. In vitro, phosphate fluoride combinations partially dissolve bone mineral content in a wider range than fluoride treatment alone in a uniform manner. With this new technique one can control more precisely the partial dissolution of the bone mineral and mineral phase's contribution to mechanical properties of bone tissue.

An in vitro model to test the contribution of advanced glycation end products to bone biomechanical properties

We developed an in vitro model which provides the ability to test the effects of advanced glycation end products (AGEs), specifically pentosidine (PEN) and one of its inhibitors, the aminoguanidine (AMG), on cortical bone. This model allows modification of the extent of collagen cross-linking, while controlling other factors known to influence bone strength. In this in vitro model, young bovine cortical bone specimens were incubated in phosphate-buffered saline (PBS)+/-ribose (RIB, an inducer of AGEs formation)+/-AMG for 15 days at 37 degrees C. The mineral and organic matrix as well as biomechanical properties were examined. We found that (i) incubation+/-treatments did not induce collagen denaturation compared to specimens that were not incubated; (ii) neither treatment or incubation time effected the concentration of trivalent enzymatic cross-links pyridinoline and deoxypyridinoline. The non-enzymatic cross-link PEN was undetectable in specimens that were not incubated or that were incubated in PBS or AMG alone. However, PEN concentration increased significantly in specimens incubated with RIB, whereas ribose-induced PEN formation was markedly inhibited by AMG. (iii) Incubation+/-treatments did not change the mineral maturity, crystallinity or microhardness assessed by X-ray diffraction, X-ray microscopy analyses, FTIRM and micro-indentation tests. (iv) PEN concentration was not associated with biomechanical properties assessed by 3-point bending. In conclusion, this in vitro incubation model of young bovine cortical bone induced physiologic concentrations of PEN in the RIB+AMG group and is the first to show that AMG inhibits ribose-induced formation of PEN cross-links in bone while not affecting the organic and mineral phases. AGE concentration did not influence bending mechanical properties; however, the simple 3-point bending test we used was likely inadequate to demonstrate effects of AGEs on mechanical properties.

Abnormal mineral-matrix interactions are a significant contributor to fragility in oim/oim bone

The presence of abnormal type I collagen underlies the tissue fragility in the heritable disease osteogenesis imperfecta (OI), though the specific mechanism remains ill-defined. The current study addressed the question of how an abnormal collagen-based matrix contributes to reduced bone strength in OI by comparing the material properties of mineralized and demineralized bone from the oim/oim mouse, a model of OI that contains homotrimeric (alpha1(3)(I)) type I collagen, with the properties of bone from wildtype (+/+) mice. Femoral three-point bend tests combined with geometric analyses were conducted on intact (mineralized) 14-week-old oim/oim and +/+ mice. To investigate the bone matrix properties, tensile tests combined with geometric analyses were conducted on demineralized femora. The majority of the properties of the mineralized oim/oim bone were inferior to those of the +/+ bone, including greater brittleness (+78.6%) and lower toughness (-69.2%). In contrast, tensile measurements on the demineralized bone revealed no significant differences between the oim/oim and +/+ bone, indicating that the matrix itself was not brittle. These results support the concept that deficient material properties of the demineralized bone matrix itself are not the principal cause of the severe fragility in this model of OI. It is likely the abnormal collagen scaffold serves as a template for abnormal mineral deposition, resulting in an incompetent mineral-matrix interaction that contributes significantly to the inferior material properties of bone in oim/oim mice.

Plastic deformation of the forearm in an adult: treatment with multiple osteotomies

Plastic deformation of the forearm is a rare and frequently missed injury in adults that can result in significant loss of forearm rotation. We report on a skeletally mature 19-year-old man with traumatic plastic deformation of the radius and ulna resulting in complete loss of forearm pronation. The patient was treated with multiple-level osteotomies of the radius and ulna 7 months postinjury. The patient had full forearm pronation at 4 months followup.

Structural and functional assessment of trabecular and cortical bone by micro magnetic resonance imaging

Osteoporosis is a multifactorial disorder of bone mineral homeostasis affecting the elderly. It is a major public health issue with significant socioeconomic consequences. Recent findings suggest that bone loss-the key manifestation of the disease-is accompanied by architectural deterioration, both affecting the bone's mechanical competence and susceptibility to fracture. This article reviews the potential of quantitative micro MRI (mu-MRI), including a discussion of the technical requirements for image acquisition, processing, and analysis for assessing the architectural implications of osteoporosis and as a means to monitor the response to treatment. With current technology, the resolution achievable in clinically acceptable scan times and necessary signal-to-noise ratio (SNR) is comparable to trabecular thickness. This limited spatial resolution regime demands processing and analysis algorithms designed to operate under such limiting conditions. It is shown that three different classes of structural parameters can be distinguished, characterizing scale, topology, and orientation. There is considerable evidence that osteoporotic bone loss affects all three classes but that topological changes, resulting from conversion of trabecular plates to rods, with the latter's eventual disconnection, are particularly prominent. Clinical applications discussed can be divided into those dealing with assessment of osteoporotic fracture risk as opposed to the study of the effect of disease progression and regression in response to treatment. Current data suggest that noninvasive assessment of cortical and trabecular bone (TB) architecture by mu-MRI may provide new surrogate endpoints to assess the efficacy of intervention in osteoporosis treatment and prevention.

Bone density spatial patterns in the distal radius reflect habitual hand postures adopted by quadrupedal primates

Primates adopt diverse hand postures during terrestrial and above-branch quadrupedal locomotion--knuckle-walking, digitigrady, and palmigrady--that incorporate varying degrees of wrist dorsiflexion (i.e., extension). Although relationships between hand postures, wrist joint range of motion, and the external properties of wrist bones (e.g., surface morphology) have been examined, the relationship between hand postures and the internal properties of wrist bones (e.g., bone density) remains largely unexplored. Because articular joint surfaces transmit mechanical loads between conjoining limb bones, measures of density (e.g., magnitudes and patterns) in the subchondral cortical plate of bone of the distal radius can be used to evaluate load regimes experienced by the wrist joint in different hand postures. We assessed apparent (i.e. optical) density patterns in several extant catarrhine primate taxa partitioned into different hand posture groups: knuckle-walking apes, digitigrade monkeys, and palmigrade monkeys. Computed tomography osteoabsorptiometry (CT-OAM) was used to construct maximum intensity projection (MIP) maps of apparent densities. High apparent density areas were characterized relative to a dorsal-volar reference plane and compared across hand posture groups. All groups had large percentage areas of high apparent density in the dorsal region of the distal radial articular surface. Only knuckle-walking apes, however, had a large percentage area of high apparent density in the volar region of the distal radial articular surface. These patterns are consistent with radiocarpal articulations in specific hand postures as evidenced by available radiographic data and suggest that the different habitual hand postures adopted by monkeys and African apes during quadrupedal locomotion have different stereotypic loading patterns. This has implications for understanding the functional morphology and evolution of knuckle-walking and digitigrade hand postures in primates.

Are bone losers distinguishable from bone formers in a skeletal series? Implications for adult age at death assessment methods

Clinical studies indicate that genetic factors play a crucial role in primary osteoarthritis and osteoporosis. In addition, it has been suggested that these two diseases are inversely related. Within a population, one can find two sub-groups: the "bone formers" and the "bone losers". The changes to the joint surfaces used to assess adult age at death are related to the loss of bone substance and to bone formation (osteophytes). The modification of these indicators with age differs between bone formers and bone losers. Therefore, age-at-death assessment methods should make use of two standards, one for each sub-group. A preliminary study examining the possibility of distinguishing those who lose cortical bone from those who show signs of bony formation was conducted on a series of skeletons from Portugal, dating to the end of 19th century and the beginning of the 20th. Bone loss was evaluated using the cortical index (CI) of the second metacarpal on X-rays. The presence of osteophytes on dry bones was assessed macroscopically. Our study indicates that females' CI decreases with age, whereas the presence of osteophytes is strongly related to age in both sexes. But we have failed to find the inverse relationship between osteophytes and bone loss. Our study, however, shows that within a population, some individuals are not likely to develop osteophytes.

Measurement of phosphorus content in normal and osteomalacic rabbit bone by solid-state 3D radial imaging

In osteomalacia decreased mineralization reduces the stiffness and static strength of bone. We hypothesized that hypomineralization in osteomalacic bone could be quantified by solid-state (31)P magnetic resonance imaging (SS-MRI). Hypomineralization was measured with a 3D radial imaging technique at 162 MHz (9.4T) in rabbit cortical bone of hypophosphatemic (HY) and normophosphatemic (NO) animals. The results were compared with those obtained by quantitative micro-CT (micro-CT) and (31)P solution NMR. 3D images of 277 microm isotropic voxel size were obtained in 1.7 hr with SNR approximately 9. Mineral content was lower in the HY relative to the NO group (SS-MRI: 9.48 +/- 0.4 vs. 11.15 +/- 0.31 phosphorus wet wt %, P < 0.0001; micro-CT: 1114.6 +/- 28.3 vs. 1175.7 +/- 23.5 mg mineral/cm(3); P = 0.003). T(1) was shorter in the HY group (47.2 +/- 3.5 vs. 54.1 +/- 2.7 s, P = 0.004), which suggests that relaxation occurs via a dipole-dipole (DD) mechanism involving exchangeable water protons, which are more prevalent in bone from osteomalacic animals.

Specimen size effect in the volumetric shrinkage of cancellous bone measured at two levels of dehydration

Water is commonly removed from bone to study its effect on mechanical behaviour; however, dehydration also alters the bone structure. To make matters worse, measuring structural changes in cancellous bone is complicated by a number of factors. Therefore, the goals of this study were to address these issues by (1) comparing Archimedes' method and a helium pycnometer as methods for measuring cancellous bone volume; (2) measuring the apparent dimensional and volumetric tissue shrinkage of cancellous bone at two levels of dehydration; and, (3) identifying whether a size effect exists in cancellous bone shrinkage. Cylindrical specimens (3, 5 and 8.3 mm diameters) of cancellous bone were taken from the distal bovine femur. The apparent dimensions of each cylindrical specimen were measured in a fully hydrated state (HYD), after drying at room temperature (AIR), and after oven drying at 105 degrees C (OVEN). Tissue volume measurements for those three hydration states were obtained using both a helium pycnometer and Archimedes' method. Aluminium foams, which mimic the cancellous structure, were used as controls. The results suggest that the helium pycnometer and Archimedes' method yield identical results in the HYD and AIR states, but that Archimedes' method under-predicts the nominal OVEN volume by incorporating the collagen-apatite porosity. A distinct size effect on volumetric shrinkage is observed (p<0.025) using the pycnometer in both AIR and OVEN states. Apparent dimensional shrinkage (2% and 7%) at the two dehydration levels is much smaller than the measured volumetric tissue shrinkage (16% and 29%), which results in a reduced dehydrated bone volume fraction.

Comparative evaluation of the peri-implant bone tissue mineral density around unloaded titanium dental implants

OBJECTIVE

The mechanical properties of bone are greatly influenced by the percentages of organic and mineral constituents. Nevertheless, the information about the mineral content on a microscopic scale in peri-implant bone is scarce. The aim of this work was to analyze the bone mineral density of peri-implant bone under different techniques.

DESIGN

Five unloaded titanium dental implants with a micro-structured surface (three XiVE plus and two Frialit 2, DENTSPLY-Friadent, Mannheim, Germany) were retrieved from the mandible of five patients after a 6-month period. scanning electron microscopy with backscattered electron signal (BSE), light microscopy (LM) with a double staining technique, fluorescence microscopy and confocal laser microscopy were used for measuring microscopic mineral content variations in peri-implant bone. Histomorphometry and image intensity (grey level) were evaluated using a software package for image analysis.

RESULTS

The low mineral density index (LMDI) for LM was of 29.2+/-3.1 (mean+/-S.D.), while the high mineral density index (HMDI) was of 88.2+/-3.6 (mean+/-S.D.). The one-way ANOVA analysis showed a significant difference (P<0.001) among the groups. The pairwise Holm-Sidak test identified the differences among HMDI indexes for both LM and SEM values and also for cross-evaluation of the LMDI and HMDI values. The comparison between LMDI indexes for both SEM and LM did not show any significance. The fluorescence microscopy analysis showed clearly the difference between old (high mineralized) and new (low mineralized) bone tissue near the implant surface. Under confocal laser microscopy the same sections showed the area of bone modelling closest to implant surface.

CONCLUSION

In this study it was found that bone around unloaded implants showed a low mineral density index under all the investigation methods used. It was also found that the conventional LM technique with the double staining method was able to intensely stain the bone area with a low mineral content.

Young-elderly differences in bone density, geometry and strength indices depend on proximal femur sub-region: a cross sectional study in Caucasian-American women

Fragility fractures at the trochanter (TR) and the femoral neck (FN) have distinct etiologies, but the underlying age-related structural changes at these proximal femoral sub-regions are poorly understood. 28 young (41+/-3 years) and 124 elderly (74+/-3 years) healthy Caucasian women underwent volumetric quantitative computed tomography at the hip. Integral (i), cortical (c) and trabecular (t) bone mineral density and content (BMD, BMC) were measured. Geometric parameters included cross sectional area (CSA), and volumes of the integral, cortical and trabecular regions (VOL). Structural measures included indices of compressive (Compstr) and bending (BSI) strength. After adjusting for height and weight, an F-test was used to compare the TR and the FN mean values between young and elderly and to test for interaction to compare logarithmic difference of young and elderly (log(Young)-log(Elderly), Y/Ed) between the FN and the TR in an ANOCOVA model. All BMC, iBMD and tBMD values were significantly lower in elderly than in young women, with the largest Y/Ed in the FN tBMC and tBMD (P<0.0011 and P<0.0001). cBMD in young and elderly groups was not significantly different at the TR while at the FN it was greater (P=0.0075) in elderly than young women, showing significant Y/Ed (P=0.0003) dependence on skeletal site. Elderly women had significantly larger iVOL and CSA values (0.0001<P<0.0051), except for the FN iVOL. cVOL values were smaller in elderly than young women (P<0.0001). Y/Ed in bone geometry differed by sub-region only for cVOL measures (P=0.0267). Despite larger CSA and iVOL measures in elderly, the younger women had greater Compstr (P<0.0001) and BSI (P=0.0051). Thus, although both the TR and the FN appear to increase in size with age, this enlargement is insufficient to protect against loss of bone strength.

Habitual use of the primate forelimb is reflected in the material properties of subchondral bone in the distal radius

Bone mineral density is directly proportional to compressive strength, which affords an opportunity to estimate in vivo joint load history from the subchondral cortical plate of articular surfaces in isolated skeletal elements. Subchondral bone experiencing greater compressive loads should be of relatively greater density than subchondral bone experiencing less compressive loading. Distribution of the densest areas, either concentrated or diffuse, also may be influenced by the extent of habitual compressive loading. We evaluated subchondral bone in the distal radius of several primates whose locomotion could be characterized in one of three general ways (quadrupedal, suspensory or bipedal), each exemplifying a different manner of habitual forelimb loading (i.e. compression, tension or non-weight-bearing, respectively). We employed computed tomography osteoabsorptiometry (CT-OAM) to acquire optical densities from which false-colour maps were constructed. The false-colour maps were used to evaluate patterns in subchondral density (i.e. apparent density). Suspensory apes and bipedal humans had both smaller percentage areas and less well-defined concentrations of regions of high apparent density relative to quadrupedal primates. Quadrupedal primates exhibited a positive allometric effect of articular surface size on high-density area, whereas suspensory primates exhibited an isometric effect and bipedal humans exhibited no significant relationship between the two. A significant difference between groups characterized by predominantly compressive forelimb loading regimes vs. tensile or non-weight-bearing regimes indicates that subchondral apparent density in the distal radial articular surface distinguishes modes of habitually supporting of body mass.

Dual-energy x-ray absorptiometry measurement and accuracy of bone mineral after unilateral total hip arthroplasty

The standard technique for monitoring bone mineral in hip arthroplasty has been dual-energy x-ray absorptiometry (DEXA). The accuracy of DEXA in the cortical bone adjacent to femoral components has not been established. This study evaluated bone mineral in the cortical bone adjacent to the femoral component comparing DEXA and ashing. Seven pairs of human femora from postmortem donors with unilateral hip implants were examined. Twenty-eight ashed core specimens from both the medial and lateral sides were taken. Cortical bone loss was seen to be greater in the proximal and medial regions of the implanted femora. Dual-energy x-ray absorptiometry failed to show an acceptable level of accuracy compared with ash data (r = 0.56; P = .002). It did show relative patterns of bone loss. Bone loss was consistent with implant-induced stress shielding.

Local variations in the micromechanical properties of mouse femur: the involvement of collagen fiber orientation and mineralization

In this study we sought to understand the material level basis for local variations in the uniaxial micromechanical properties of mouse cortical bone. It was hypothesized that the opposing anterior and posterior quadrants will significantly differ in terms of their mechanical function, such that, the anterior portion will be stronger in tension whereas the posterior quadrant will be stronger in compression. Mechanical properties were assessed via microtensile and microcompressive tests of standardized coupon-shaped specimens from femurs of Swiss Webster mice (9 weeks). The mineralization and mineral quality was assessed via Raman spectroscopy and the overall collagen orientation was investigated with quantitative polarized imaging. Micromechanical tests demonstrated that the modulus, yield stress, maximum stress and fracture energy of the posterior quadrant was 66%, 53%, 42% and 31% of anterior quadrant; however, the compressive properties did not differ between the two quadrants. Raman microspectroscopic analysis indicated that the mineral matrix ratio, mineral crystallinity and carbonation did not vary between the quadrants. However, the collagen fibers in the anterior quadrant were significantly (p<0.05) more oriented along the longer axis of the diaphyseal shaft than the collagen fibers of the posterior quadrant. Therefore, we concluded that the orientation of collagen fibers with respect to the anatomical loading axis has a profound effect on the uniaxial mechanical function of murine bone. It will be a matter of further research to reveal the role of local variations in the mode of stress on this material level dichotomy in tissue organization and mechanical function.

Determining the degree of cortical bone asymmetry in bilateral, nonpathological, human femur pairs

When testing the effects of a femoral component on cortical bone following total hip arthroplasty, the patient's implanted femur is often compared with his/her contralateral nonimplanted femur, with differences attributed to the femoral component. However, if normal anatomical differences exist between bilateral femurs, they need to be quantified in order to validate whether the differences between implanted and nonimplanted bilateral femurs are due to the implant or possibility due to intrinsic differences before implantation. This study quantified the geometric properties of cortical bone shape between seven pairs of bilateral, cadaveric, human femurs. The null hypothesis tested stated that the bilateral femurs would not be significantly different in cortical bone geometry. Digitized images of cortical bone cross-sections taken at percent biomechanical lengths (levels 1-8) were used to calculate bone geometry measurements. The paired t-test showed that the only significant difference was in the location of principal axes at the most proximal location, level 1 (p = 0.015). All other measurements and levels were not significant with percent differences less than 6.6%. In conclusion, the data supports attributing cortical bone shape differences between implanted and contralateral nonimplanted femurs in levels 2-8 to the presence of the implant when the significant differences are greater than 6.6%.

Antler stiffness in moose (Alces alces): Correlated evolution of bone function and material properties?

The material properties of bone can vary considerably among skeletal elements from different parts of the body that serve different functions. However, functional demands placed on a specific type of skeletal element also can vary at a variety of scales, such as between different parts of the element, among individuals of a species, and across species. Variation in bone material properties might be correlated with differing functional demands at any of these scales. In this study we performed three-point bending tests on bone specimens extracted from antlers of moose (Alces alces) to test for three types of variation in bone material stiffness (Young's modulus): within the antler structure, between populations of moose, and between moose and other deer species. Because superficial portions of the antler are exposed to greater bending stress and strain than deeper portions, and because the antler beam (the basal shaft that attaches to the skull) is subjected to greater bending moments than more distal parts of the antler, we predicted that superficial bone and bone from the beam would be stiffer than bone from other parts of the antler. Instead, we identified no significant differences in these comparisons. There were also no significant differences in antler stiffness between moose from Michigan and the Yukon, even though the rapid growth required of antlers from northern latitudes like the Yukon has the potential to compromise bone material properties. However, moose have significantly stiffer antlers (11.6 +/- 0.45 GPa, mean +/- SE) than any other deer in the odocoileine lineage. Moreover, phylogenetic reconstructions of the evolution of antler stiffness in deer indicate a strong potential that high antler stiffness is a derived feature of moose. The unusual palmate shape of moose antlers likely subjects their antler beams to higher bending moments than found in other odocoileines, a factor that may have contributed to the evolutionary divergence of moose antler stiffness from that of other members of this clade. Although similarities in the mineral composition of bone across species likely limit the overall range of phylogenetic variation in bone material properties, our results demonstrate that evolutionary diversity in bone material properties can show correspondence with phylogenetic differences in mechanical or ecological demands on skeletal elements.

Application of Fracture Mechanics to Failure in Manatee Rib Bone

Background. The Florida manatee (Trichechus manatus latirostris) is listed as endangered by the U.S. Department of the Interior. Manatee ribs have different microstructure from the compact bone of other mammals. Biomechanical properties of the manatee ribs need to be better understood. Fracture toughness (KC) has been shown to be a good index to assess the mechanical performance of bone. Quantitative fractography can be used in concert with fracture mechanics equations to identify fracture initiating defects∕cracks and to calculate the fracture toughness of bone materials. Method of approach. Fractography is a standard technique for analyzing fracture behavior of brittle and quasi-brittle materials. Manatee ribs are highly mineralized and fracture in a manner similar to quasi-brittle materials. Therefore, quantitative fractography was applied to determine the fracture toughness of manatee ribs. Results. Average fracture toughness values of small flexure specimens from six different sizes of manatees ranged from 1.3to2.6MPa(m)1∕2. Scanning electron microscope (SEM) images show most of the fracture origins were at openings for blood vessels and interlayer spaces. Conclusions. Quantitative fractography and fracture mechanics can be combined to estimate the fracture toughness of the material in manatee rib bone. Fracture toughness of subadult and calf manatees appears to increase as the size of the manatee increases. Average fracture toughness of the manatee rib bone materials is less than the transverse fracture toughness of human and bovine tibia and femur.

Determinants of skeletal fragility

Strategies to reduce fracture risk must be based on a sound understanding of the mechanisms that underline the increased incidence of fractures with age and with certain diseases. There is evidence that in addition to bone minerals density, other factors influence bone strength. The chapter reviews the biomechanical aspects of age-related fractures, including the interacting roles of traumatic loading and bone strength, and the factors that determine a bones resistances to fracture. Also discussed are the mechanisms by which anti-catabolic and anabolic therapies for osteoporosis may affect bone strength. Finally, several current and future methodologies for improving assessment of bone strength in patients are evaluated.

Nuclear magnetic resonance studies of bone water

Mineralized bone tissue has a significant water component. Bone water is associated with the collagen fibers or mineral fraction or occurring as pore water of the Haversian and lacunocanalicular system. Among the multiple physiologic functions that include signaling and providing to bone its viscoelastic properties, bone water enables the transport of ions and nutrients to and waste products from the cells. In addition, it plays a key role during mineralization whereby collagen-bound water is gradually replaced by calcium apatite-like mineral. In this review it is shown how nuclear magnetic resonance (NMR) allows the study of various physiologically relevant properties of bone water nondestructively. Isotope exchange experiments are described from which the apparent water diffusion coefficient can be calculated. The method is based on monitoring the migration of H2O into the D2O after immersion of the specimen in heavy water. Data obtained from rabbit cortical bone in the normal and mineral-depleted skeleton provide evidence for the hypothesized reciprocal relationship between bone water and mineral. Further, from the diffusion coefficient (Da = (7.8+/-1.5) x 10(-7) cm2/s) measured at 40 degrees C it can be inferred that diffusive transport of small molecules from the bone's microvascular system to the osteocytes occurs within minutes. Finally, whereas isotope exchange is not feasible in vivo, it is shown that bone water can be imaged by proton MRI.

Effect of ultrastructural changes on the toughness of bone

The ultrastructure of bone can be considered as a conjunction between the biology and the biomechanics of the tissue. It is the result of cellular and molecular activities of bone formation, and its organization dominates the mechanical behavior of bone. Following this perspective, the objective of this review is to provide a current understanding of bone ultrastructure and its relationships with the toughness of the tissue. Therefore, we first provide a discussion on the organization of bone constituents, namely collagen, mineral, and water. Then, we present evidence on how the toughness of bone relates to its ultrastructure through the formation of micro damage. In addition, attention is given to how damage accumulation serves as a toughening mechanism. Finally, we describe how changes in the ultrastructure-caused by osteogenesis imperfecta, gamma irradiation, fluoride treatment, and aging affect the toughness and competence of bone.

Infrared spectroscopic characterization of mineralized tissues

Vibrational spectroscopy (Infrared and Raman), and in particular micro-spectroscopy and micro-spectroscopic imaging has been used to characterize developmental changes in bone and other mineralized tissues, to monitor these changes in cell cultures, and to detect disease and drug-induced modifications. Examples of the use of infrared micro-spectroscopy and micro-spectroscopic imaging are discussed in this review.

Relationships among microstructural properties of bone at the human midshaft femur

Mineralization density and collagen fibre orientation are two aspects of a bone's microstructural organization that influence its mechanical properties. Previous studies by our group have demonstrated a distinctly non-random, though highly variable, spatial distribution of these two variables in the human femoral cortex. In this study of 37 specimens, these variables are examined relative to one another in order to determine whether regions of bone demonstrating higher or lower mineralization density also demonstrate a prevalence of either transversely or longitudinally oriented collagen fibres. An analysis of rank-transformed collagen fibre orientation (as determined by circularly polarized light) and mineralization density (as determined by backscattered electron microscopy) data sets demonstrated that areas of low mineralization density (predominantly in the anterior-lateral cortex) tended to correspond to regions of higher proportions of longitudinally oriented collagen fibres. Conversely, areas of higher mineralization density (postero-medially) tended to correspond to regions of higher proportions of transversely oriented collagen fibres. High variability in the sample led to generally low correlations between the two data sets, however. A second analysis focused only on the orientation of collagen fibres within poorly mineralized bone (representing bone that was newly formed). This analysis demonstrated a lower proportion of transverse collagen fibres in newly formed bone with age, along with some significant regional differences in the prevalence of collagen fibres of either orientation. Again high variability characterized the sample. These results are discussed relative to the hypothesized forces experienced at the midshaft femur.

Bone mineralization density and femoral neck fragility

The traditional view of osteoporotic fractures is that they result from a reduction in bone mass combined with alterations in the micro-architecture. Apart from the effects of bone remodeling, the material properties of the remaining bone are thought to be unaffected. To test this, we compared the degree of matrix mineralization in femoral neck biopsies taken from cases of intracapsular hip fracture with age- and sex-matched postmortem controls. Whole femoral neck biopsies from seven female hip fracture cases (72-90 years) and nine controls (68-94 years) were embedded in methylmethacrylate, and sections stained with Solochrome Cyanin R for analysis of osteoid. The blocks were then diamond micro-milled, carbon coated, and analyzed for the degree of matrix mineralization using halogenated dimethacrylate standards for quantitative backscattered electron (qBSE) imaging (20 kV, entire block face, sampling interval 5 microm). The BSE gray scale was adjusted such that 0 corresponds to an electron backscattering coefficient of 0.1159 (approximately 1.70 g/ml) and 255-0.1519 (approximately 2.18 g/ml). Remodeling and mineralization data were analyzed for both the whole biopsy face and on a regional (anterior; inferior, posterior, or superior) basis. Over the whole biopsy, the level of mineralization was lower in the cases than the postmortem controls (-2.8%, P < 0.05). In both cases and controls, cortical mineralization was higher in the inferior (compressive) region compared with superior (tensile) region (P < 0.05). Mineralization was lower in all regions of the cases (inferior: -3.3%; posterior: -3.1%; anterior: -2.7%; superior: -1.6%) compared to the controls. Mineralization density in cancellous bone was not regionally dependent but was lower in the fracture cases (-3.5%; P = 0.001). Although there were weak relationships between osteoid formation (%O.Ar/B.Ar) and the mean level of mineralization in both cortical (P = 0.068) and cancellous (P < 0.01) bone, adjustment for this did not markedly affect the case-control differences. In conclusion, this study has shown that in cases of intracapsular hip fracture, matrix mineralization is reduced in the femoral neck. Unexpectedly, in view of the likely role of mild to moderate vitamin D deficiency osteopathy in hip fracture, this decreased mineralization was independent of osteoid indices and therefore potentially independent of bone age. This raises the possibility that alterations in the bone matrix such as excessive glycation or changes in the composition of the collagen fibrils affect its mineralization in hip fracture cases.

Estrogen, androgen, and the pathogenesis of bone fragility in women and men

During growth, estrogen deficiency in females may produce increased bone size as a result of removal of inhibition of periosteal apposition, while failed endosteal apposition produces thin cortices and trabeculae in the smaller bone. In males, androgen deficiency produces reduced periosteal and endosteal apposition, reduced bone size, and cortical and trabecular thickness. At completion of longitudinal growth, advancing age is associated with emergence of a negative bone balance in each basic multicellular unit (BMU) because of reduced bone formation. Bone loss occurs, but slowly because the remodeling rate is slow. In midlife, in females, estrogen deficiency increases remodeling rate, increases the volume of bone resorbed, and decreases the volume of bone formed in each of the numerous BMUs remodeling bone on its endosteal (endocortical, trabecular, intracortical) surfaces so bone loss accelerates. In males, remodeling rate remains slow and is driven largely by reduced bone formation in the BMU. Hypogonadism in 20% to 30% of elderly men contributes to bone loss. In both sexes, calcium malabsorption and secondary hyperparathyroidism may partly be sex-hormone dependent and contributes to cortical bone loss. Concurrent periosteal apposition partly offsets endosteal bone loss, but less so in women than in men. More women than men fracture because their smaller skeleton incurs greater architectural damage and adapts less by periosteal apposition. Sex hormone deficiency during growth and aging is pivotal in the pathogenesis of bone fragility.

Invited Review: Pathogenesis of osteoporosis

Patients with fragility fractures may have abnormalities in bone structural and material properties such as larger or smaller bone size, fewer and thinner trabeculae, thinned and porous cortices, and tissue mineral content that is either too high or too low. Bone models and remodels throughout life; however, with advancing age, less bone is replaced than was resorbed within each remodeling site. Estrogen deficiency at menopause increases remodeling intensity: a greater proportion of bone is remodeled on its endosteal (inner) surface, and within each of the many sites even more bone is lost as more bone is resorbed while less is replaced, accelerating architectural decay. In men, there is no midlife increase in remodeling. Bone loss within each remodeling site proceeds by reduced bone formation, producing trabecular and cortical thinning. Hypogonadism in 20-30% of elderly men contributes to bone loss. In both sexes, calcium malabsorption and secondary hyperparathyroidism increase remodeling: more bone is removed from an ever-diminishing bone mass. As bone is removed from the endosteal envelope, concurrent bone formation on the periosteal (outer) bone surface during aging partly offsets bone loss and increases bone's cross-sectional area. Periosteal apposition is less in women than in men; therefore, women have more net bone loss because they gain less on the periosteal surface, not because they resorb more on the endosteal surface. More women than men experience fractures because their smaller skeleton incurs greater architectural damage and adapts less by periosteal apposition.

Cortical bone in the human femoral neck: three-dimensional appearance and porosity using synchrotron radiation

A high-resolution CT system using synchrotron radiation allowed visualization of the 3D cortical bone microarchitecture and measurement of intracortical porosity of femoral neck cortical bone specimens from 19 female cadavers imaged at 10.13-microm resolution. 3D reconstruction of specimens showed osteonal system arrangement. Mean porosity was 15.88%. This technique will provide insights into the mechanisms involved in osteoporotic hip fractures.

INTRODUCTION

The purpose of this study was to show that a high-resolution CT system using synchrotron radiation (SR) allows visualization of the 3D cortical bone microarchitecture of the human femoral neck and quantification of intracortical porosity.

MATERIALS AND METHODS

Bone specimens from the inferior femoral neck were obtained from 19 female cadavers with no hip fracture (mean, 86.9 +/- 8.3 years). The specimens, consisting of embedded approximately 7 x 7 x 12-mm cortical bone parallelepipeds, were imaged using SR at 10.13-microm resolution. Commercial software was used to visualize both the 660 x 660 x 660-voxel volumes and the 2D axial slices through each volume. Qualitative examination of 2D axial slices focused on the appearance of the vessel canal system, presence of small bright zones (fully mineralized tissue) in the osseous matrix, and presence of cracks. A method was developed to automatically measure 3D intracortical porosity after separating pure bone from pores and cortical bone from trabecular bone.

RESULTS AND CONCLUSIONS

3D reconstruction of the specimens showed the entire structure and arrangement of the osteonal systems, parallel to the axis of the femoral neck. Bright zones were seen in the outer cortex. No cracks were observed. Porosity values varied widely from 4.96% to 38.87% (mean, 15.88 +/- 9.87%). This study establishes that SR microtomography can be used to display the 3D bone microstructure of the human femoral neck cortex and to quantify intracortical porosity. This technique will provide insights into the mechanisms involved in cortical bone loss and osteoporotic hip fractures.

Changes in bone mineral density explain little of the reduction in vertebral or nonvertebral fracture risk with anti-resorptive therapy

The structural basis for the reduction in vertebral and nonvertebral fracture risk in patients using anti-resorptive therapy is not well understood. As reduced bone mineral density (BMD) increases the risk for fracture and anti-resorptive agents increase BMD, it was commonly held that the increase in BMD explained the fracture risk reduction until several meta-analyses either failed to detect a significant association between vertebral fracture risk reduction and the incremental increase in BMD or reported that only a small proportion of the vertebral fracture risk reduction was explained by changes in BMD. Recently, it was reported that the risk of nonvertebral fractures decreased when an increase in BMD accompanied anti-resorptive treatment [J. Clin. Endrocrinol. Metab. 87 (2002) 1586]. However, a reanalysis of the data, using the same statistical methods after correcting for discrepancies in the reported BMD and person-year data, suggested that the magnitude of reductions in nonvertebral fracture risk was not associated with the magnitude of increases in BMD at the end of the first year or at completion of the studies. We infer that only a small proportion of risk reduction in vertebral and nonvertebral fractures observed with anti-resorptive drug therapy is explained by the increase in BMD. Further studies are needed to define the structural basis of the fracture risk reduction.

Teriparatide [PTH(1-34)] strengthens the proximal femur of ovariectomized nonhuman primates despite increasing porosity

OVX monkeys treated for 18 months with 1 or 5 microg/kg/d teriparatide [PTH (1-34)] had significantly stronger proximal femora relative to ovariectomized controls. Teriparatide enhancement of cortical area, cortical width, and trabecular bone volume seemed to more than compensate for the dose-dependent increase in cortical porosity. Beneficial effects of teriparatide treatment on the proximal femur persisted beyond the treatment period and may extend to the marrow.

INTRODUCTION

We conducted a detailed quantitative analysis of the effects of teriparatide on the proximal femur of ovariectomized monkeys. Teriparatide increased bone mass, enhanced structural architecture, and strengthened the hip, despite increasing cortical porosity.

MATERIALS AND METHODS

Monkeys were treated with vehicle (sham or OVX controls), 1 microg/kg/day teriparatide [parathyroid hormone (1-34); PTH1], or 5 microg/kg/day teriparatide (PTH5) for 18 months or for 12 months followed by 6 months of treatment withdrawal (PTH1W and PTH5W, respectively). Excised proximal femora were analyzed by microCT, conventional histomorphometry, and biomechanics.

RESULTS AND CONCLUSIONS

The femoral neck showed significant reduction in trabecular bone volume (BV/TV) for OVX compared with sham, whereas PTH1 BV/TV was restored to sham levels and PTH5 BV/TV was greater than sham and OVX. The withdrawal groups had BV/TVs intermediate between sham and OVX. PTH1 had trabecular number (Tb.N) greater than OVX, and PTH5 Tb.N was greater than sham and OVX. The withdrawal groups had Tb.Ns intermediate between sham and OVX. No differences between groups were observed for trabecular orientation or trabecular thickness. Teriparatide dose-dependently increased bone formation rate and activation frequency in the femoral neck. Cellular composition analyses suggested a tendency of ovariectomy to increase adiposity of marrow by 100%, whereas PTH tended to reduce adipocyte number and increase osteoblast number compared with OVX. Analyses of the cortex showed dose-dependent elevation of cortical porosity, which was consistent with enhanced bone turnover with treatment. Cortical porosity was reduced after withdrawal of teriparatide, because PTH1W cortical porosity was lower than OVX, whereas PTH5W cortical porosity was intermediate between sham and OVX. Increased cortical porosity did not weaken the proximal femora. Biomechanics showed that ovariectomy weakened proximal femora compared with sham, but PTH1, PTH5, and PTH1W were stronger than OVX and not different from sham. PTH5W strength was intermediate between sham and OVX. Therefore, teriparatide had beneficial effects on the proximal femur, despite increasing cortical porosity. Cortical porosity did not adversely affect the mechanical integrity of the proximal femora, because enhanced cortical area and trabecular bone volume more than compensated for the porosity. Much of the beneficial effects of teriparatide were retained after 6 months withdrawal from treatment. PTH effects on the femoral neck were not limited to bone but may include inhibition of OVX-stimulated adiposity of the marrow.

[A new implant for proximal humeral fracture: experimental study of the basket plate]

PURPOSE OF THE STUDY

We conducted a comparative study of three ostheosynthesis systems for proximal humeral fractures. The conclusions led to the elaboration of a rigid extramedullary osteosynthesis implant. This novel implant allows specific fixation of the tuberosities via six adjustable and removable hooks organized like a basket. There are two versions, with and without a central cephalic locking screw. We report two static biomechanical studies conducted to analyze this material.

MATERIAL AND METHODS

The two studies were performed on fresh frozen cadaver specimens with known bone density and with an experimental model of a four-fragment fracture of the proximal humerus. The first tests were designed to measure axial pressure reproducing the physiological movement applying the most stress on the head of the humerus. This allowed a global analysis of the mechanical behavior of the implant and an assessment of the contribution of the central cephalic locking screw. The second series of tests were traction tests used to analyze the behavior of the tuberosities fixed with the hooks. We assess the assemblies by measuring the mechanical resistance: rigidity of the fixation was recorded in mm/100N. Pre- and post-procedure x-rays and photographs were obtained to allow a subjective assessment of fragment displacement.

RESULTS

The first series of tests demonstrated that the implant, with the central cephalic locking screw, presented good overall mechanical properties. The notion of better stability of the tuberosities obtained with the hooks, as seen during the first tests, was reinforced by the data from the second tests, although no statistically significant difference was demonstrated. We also noted that there was no statistically significant correlation between bone density and the slopes of the force-resistance curves.

DISCUSSION

This prototype implant has an overall mechanical resistance equivalent to the reference implant, with at least equivalent performance. Proof of the usefulness of the central locking screw was not established, even though improved tolerance to loading by better force distribution seemed apparent. The contribution of the hook basket was not demonstrated. Data from the observations do however suggest the expectations of the implant will be fulfilled. Tests conducted on a larger scale would probably demonstrate a difference. It is clear that the small number of implants used here limited the study. Comparison with data in the literature show that this new prototype is adapted to the mechanics of the proximal humerus. Resistant to physiological stress, the implant allows pendular movement and passive physical therapy during the early post-operative period.

Water content measured by proton-deuteron exchange NMR predicts bone mineral density and mechanical properties

NMR was used to measure matrix water content in normal and hypomineralized cortical bone. Water content showed an inverse relationship with mineral content, suggesting it could serve as a surrogate measure for the bone's degree of mineralization.

INTRODUCTION

So far, true bone mineral density (DMB; degree of mineralization of bone) can not be measured nondestructively.

MATERIALS AND METHODS

Here, a new technique combining 1H nuclear magnetic resonance (NMR) spectroscopy and deuterium isotope exchange was used to measure water content in cortical bone from two groups of rabbits: a control group and a group fed a low-phosphorus (P) diet to induce hypomineralization of the bone matrix.

RESULTS

NMR-derived water content was higher in the P-depleted group and showed an inverse relationship with mineral content (measured gravimetrically and by 31p NMR). Hypomineralized bone was found to be weaker than normal bone as demonstrated by mechanical testing. More importantly, the data showed a strong inverse correlation between water content and bone mechanical properties, which indicates that water content could be predictive of the bone's mechanical competence.

CONCLUSIONS

Water content could potentially serve as a surrogate measure for the bone's degree of mineralization, and this technique could be used to study other disorders of mineral homeostasis known to alter the mineralization state of the matrix. Although the method presented here is not suitable for in vivo measurements of bone water content, the authors have previously shown that 1H NMR images of bone can be acquired; thus, noninvasive quantification of bone water may be feasible.

Relationships of loading history and structural and material characteristics of bone: Development of the mule deer calcaneus

If a bone's morphologic organization exhibits the accumulated effects of its strain history, then the relative contributions of a given strain stimulus to a bone's development may be inferred from a bone's hierarchical organization. The artiodactyl calcaneus is a short cantilever, loaded habitually in bending, with prevalent compression in the cranial (Cr) cortex, tension in the caudal (Cd) cortex, and shear in the medial and lateral cortices (i.e., neutral axis). Artiodactyl calcanei demonstrate unusually heterogeneous structural and material organization between these cortices. This study examines potential relationships between developmental morphologic variations and the functional strain distribution of the deer calcaneus. One calcaneus was obtained from each of 36 (fetus to adult) wild deer. Predominant collagen fiber orientation (CFO), microstructural characteristics, mineral content (% ash), and geometric parameters were determined from transversely cut segments. Radiographs were examined for arched trabeculae, which may reflect tension/compression stress trajectories. Results showed that cross-sectional shape changes with age from quasi-circular to quasi-elliptical, with the long axis in the cranial-caudal direction of habitual bending. Cranial ("compression") cortical thickness increased at a greater rate than the Cd ("tension") cortex. Fetal bones exhibited arched trabeculae. Percent ash was not uniform (Cr > Cd), and this disparity increased with age (absolute differences: 2.5% fetuses, 4.3% adults). Subadult bones showed progressively more secondary osteons and osteocyte lacunae in the Cr cortex, but the Cd cortex tended to have more active remodeling in the subadult and adult bones. Nonuniform Cr:Cd CFO patterns first consistently appear in the subadults, and are correlated with secondary bone formation and habitual strain mode. Medial and lateral cortices in these groups exhibited elongated secondary osteons. These variations may represent "strain-mode-specific" (i.e., tension, compression, shear) adaptations. The heterogeneous organization may also be influenced by variations in longitudinal strain magnitude (highest in the Cr cortex) and principal strain direction-oblique in medial-lateral cortices (where shear strains also predominate). Other factors such as local reductions in longitudinal strain may influence the increased remodeling activity of the Cd cortex. Some structural variations, such as arched trabeculae, that are established early in ontogeny may be strongly influenced by genetic- or epigenetic-derived processes. Material variations, such as secondary osteon population densities and CFO, which appear later, may be products of extragenetic factors, including microdamage.

Tensile damage and its effects on cortical bone

Plexiform bovine bone samples are repeatedly loaded in tension along their longitudinal axis. In order to induce damage in the bone tissue, bone samples are loaded past their yield point. Half of the bone samples from the damaged group were stored in saline to allow for viscoelastic recovery while the others were decalcified. Tensile tests were conducted on these samples to characterize the effects of damage on the mechanical behavior of the organic matrix (decalcified samples) as well as on bone tissue (stored in saline). The ultimate strain of the damaged decalcified bone is 29% higher compared to that of non-damaged decalcified (control) bone. The ultimate stresses as well as the elastic moduli are similar in both decalcified groups. This phenomenon is also observed in other collagenous tissue (tendon and ligament). This may suggest that damage in bone is caused by shear failure of the organic matrix; transverse separation of the collagen molecules or microfibrils from each other. In contrast, there is a trend towards lowered ultimate strains in damaged bone, which is soaked in saline, with respect to control bone samples (not damaged). The damaged bone tissue exhibits a bi-linear behavior in contrast to the mechanical behavior of non-damaged bone. The initial elastic modulus (below 55 MPa) and ultimate strength of damaged bone are similar to that in non-damaged bone.

Ash Content Modulation of Torsionally Derived Effective Material Properties in Cortical Mouse Bone

The purpose of this study was to evaluate the effects of isolated alterations in mineral content on mouse bone torsional properties. The femora and tibiae from 25 eight-week-old male A/J strain mice were divided into five groups and selectively decalcified from 5% to 20%. The right femora were then tested to failure in torsion while the tibiae were ashed to determine final mineral content of the decalcified bones. Contralateral femora were serially cross-sectioned to determine geometric properties, and effective material properties were then calculated from the geometric and structural properties of each femoral pair. We found that the relationship between ash content and effective shear modulus or maximum effective shear stress could best be characterized through a power law, with an exponential factor of 6.79 R2=0.85 and 4.04 R2=0.67, respectively. This indicates that in a murine model, as with other species, small changes in ash content significantly influence effective material properties. Furthermore, it appears that (in adolescent A/J strain mice) effective shear modulus is more heavily affected by changes in mineralization than is maximum effective shear stress when these properties are derived from whole bone torsional tests to failure.

Regional differences in cortical bone organization and microdamage prevalence in Rocky Mountain mule deer

The limb bones of cursorial mammals may exhibit regional structural/material variations for local mechanical requirements. For example, it has been hypothesized that mineral content (%ash) and secondary osteon population density (OPD) progressively change from proximal (e.g., humerus) to distal (e.g., phalanx), in accordance with corresponding progressive changes in stress and mechanical/metabolic cost of functional use (both greatest in the distal limb). We tested this hypothesis in wild-shot Rocky Mountain mule deer by examining transverse segments from mid-diaphyses of medial proximal phalanges, principal metacarpals, radii, and humeri, as well as the lateral aspects of sixth ribs from each of 11 mature males. Quantified structural parameters included the section modulus (Z), polar moment of inertia (J), cortical area/total area ratio (CA/TA), bone girth, and cortical thickness. In addition, %ash and the prevalence of in vivo microcracks were measured in each bone. Thin sections from seven animals were further examined for OPD and population densities of new remodeling events (NREs). Results showed a significant progressive decrease in %ash from the humerus (75.4% +/- 0.9%) to the phalanx (69.4% +/- 1.1%) (P < 0.0001), with general proximal-to-distal increases in OPD and general decreases in J and Z. Thirteen microcracks were identified in the rib sections, and only two were observed in the limb bones. Although the ribs had considerably greater NREs, no significant differences in NREs were found between the limb bones, indicating that they had similar remodeling rates. Equivalent microcrack prevalence, but nonequivalent structural/material organization, suggests that there are regional adaptations that minimize microcrack production in locations with differences in loading conditions. The progressive proximal-to-distal decrease in %ash (up to 6%); moderate-to-high correlations between OPD, %ash, J, and CA/TA; and additional moderate-to-high correlations of these parameters with each bone's radius of gyration support the possibility that these variations are adaptations for regional loading conditions.

Intrapopulation variability in mineralization density at the human femoral mid-shaft

One of several microstructural variables known to affect the mechanical properties of bone is the degree of mineralization of bone matrix. The aim of this study was to examine mineralization density, and its variability with age and sex, from a biomechanical perspective. Histological sections, prepared from mid-shaft femora obtained at autopsy from 40 individuals, were imaged using quantitative backscattered electron microscopy. Each cross-section montage was divided into 48 segments according to anatomical position. Mean grey-level values were quantified for each segment. One-way ANOVA with Tukey HSD post hoc tests were used to test for differences in mineralization between segments, age groups and sexes. Results showed a decrease in overall degree of mineralization density with adult age, but an increase in its coefficient of variation. Degree of mineralization was significantly lower in the periosteal third of the cortex, particularly in the antero-lateral aspect. This pattern was most prevalent amongst the youngest individuals in the sample. Whereas males between ages 45-64 years had a higher average degree of mineralization than females, the opposite was true of the older age group. Mineralization significantly decreased between middle and older age groups in males, but not in females. Despite limited consistencies in the location of high and low average mineralization bone through the cortex, the degree of interindividual variation, even within a single age and sex group, overwhelmed population level trends. The patterns of variability identified in this study are consistent with results of an analysis of collagen fibre orientation using the same sample material.

The structural and biomechanical basis of the gain and loss of bone strength in women and men

Structural failure (fracture) is a problem in biomechanics. Its solution resides, in part, in identifying the material and structural properties of bone that determine its mechanical resistance to structural failure. Bones must be stiff so that they do not bend when loaded, otherwise movement against gravity would not be possible. However, bones must also be flexible, otherwise their ability to absorb energy by elastic and plastic deformation will decrease and the energy imparted will be dissipated only by microdamage or complete fracture. Thus, failure may occur if bones deform too much (exceeding their peak strain) or too little (exceeding their peak stress). Phylogeny and ontogeny make bone "just right" for the functions it is predicted to perform, but the genetic material was not warned about the increased longevity the female enjoys after ovarian failure. Age-related and menopause-related abnormalities in bone remodeling produce loss of the material and structural properties that no longer keep bone "just right". High remodeling reduces the mineral content of bone tissue resulting in loss of stiffness (resistance to shortening in compression and lengthening in tension when loaded). Sex hormone deficiency increases the volume of bone resorbed and reduces the volume of bone formed in each BMU. Solutions to the biomechanic problem will emerge provided that the material and structural properties of bone that determine its strength are measured and studied. Drugs are available to reduce remodeling rate so that there is more time for completion of secondary mineralization to restore bone stiffness. If remodeling is suppressed too much the production of microdamage may increase as homogeneous and highly mineralized bone is less resistant to microdamage progression while reduced remodeling targeted to microdamage may result in microdamage accumulation. Drugs are available to reduce osteoclastic bone resorption and increase osteoblastic bone formation, which together will restore bone balance in the BMU and so prevent further loss of bone mass, prevent thinning and loss of trabeculae, thinning of cortices, and progression of porosity. These approaches prevent the progression of fragility but will not restore bone architecture. Even if a positive BMU balance is achieved, drugs that reduce remodeling are unlikely to reverse the structure damage. Slow remodeling means there are too few remodeling foci depositing their small net positive bone volume to progressively thicken cortices or trabeculae. Agents that are anabolic, that increase bone formation on the periosteal and endosteal surfaces are needed to restore the structure of bone. Other articles in this volume address this challenge. We do not understand the proportional contributions made by differences in bone size, cortical thickness, trabecular number, thickness, connectivity, tissue mineral content, microdamage burden, osteocyte density, porosity, to differences in spine and hip fracture rates within a sex, between sexes, between races, or between treatment, and control arms in clinical trials. The challenge for the future is to measure these specific materials and structural determinants of bone strength. Whether a combination of these material and structural properties will more accurately identify women likely to sustain fractures, or improve approaches to drug therapy is unknown. The quest to eliminate fragility fractures is a distant horizon seen through a glass darkly at this time.

Reduced bone formation and increased bone resorption: rational targets for the treatment of osteoporosis

The net amount of bone lost during aging is determined by the difference between the amount of bone removed from the endocortical, trabecular and intracortical components of its endosteal (inner) envelope and formed beneath its periosteal (outer) envelope. Endosteal bone loss is determined by the remodeling rate (number of basic multicellular units, BMUs) and the negative balance (the difference between the volumes of bone resorbed and formed in each BMU). Bone loss already occurs in young adult women and men and is probably due to a decline in the volume of bone formed in each BMU. The rate of loss is slow because the remodeling rate is low in young adulthood. Bone loss accelerates in women at menopause because remodeling intensity increases and BMU balance becomes more negative as estrogen deficiency reduces osteoblast lifespan and increases osteoclast lifespan. The high remodeling rate also reduces the mineral content of bone tissue. The negative BMU balance results in trabecular thinning, disappearance and loss of connectivity, cortical thinning and increased intracortical porosity. These changes compromise the material and structural properties of bone while concurrent age-related subperiosteal bone formation increases the cross-sectional area (CSA) of bone partly offsetting endosteal bone loss and the loss of structural and material strength. Thus, treatments aimed at reducing the progression of bone fragility, and reversing it, should reduce activation frequency and so reduce the number of remodeling sites, reduce osteoclastic resorption in the BMU, and so reduce the volume of bone resorbed on each of the three components of the endosteal surface thereby reducing the progression of trabecular thinning, loss of connectivity, cortical thinning and porosity. If treatment also increases periosteal bone formation, the CSA of the whole bone and its cortical area will increase. If treatment also increases endosteal bone formation in the BMU, bone balance will be less negative, especially if resorption depth is reduced. This may produce thickening of trabeculae provided activation frequency is not too low. If treatment can increase de novo bone formation at quiescent endosteal surfaces, this will increase cortical and trabecular thickness, and reduce intracortical porosity. In this way, drugs directed at both the resorptive and formative aspects of remodeling, and bone modeling may (i) increase compressive and bending strength of cortical bone by increasing the diameter of the whole bone, its CSA and the distance the cortical mass is placed from the neutral long bone axis; (ii) maintain or increase peak compressive stress and peak strain in trabecular bone, preventing microcracks and buckling; and (iii) increase the material density of bone tissue, an effect that probably should not be permitted to reach a level which reduces resistance to microdamage accumulation and progression (toughness).

Material properties of the inner and outer cortical tables of the human parietal bone

Even though the cranial vault functions as protection for the brain and as a support structure for facial and masticatory functions, little is known about its mechanical properties or their variations. The cranial vault bone is interesting because of its maintenance in spite of low functional strains, and because calvarial bone cells are often used in cell culture studies. We measured thickness, density, and ash weight, and ultrasonically determined elastic properties throughout the cortices of 10 human parietal bones. The results are unique for studies of the cranial vault because: 1) measurements focused specifically on the cortical components, 2) the orientations of the axes of maximum stiffness were determined before measurement of elastic properties, and 3) two related measurements (bone density and percent ash weight) were compared. Results showed that the periosteal cortical plate (outer table) and the endosteal cortical plate (inner table) had significant differences in material properties. The outer table was on average thicker, denser, and stiffer than the inner table, which had a higher ash weight percentage. Within each table there were significant differences in thicknesses, ash weight percentages, and E(2)/E(3) anisotropies among sites. Few sites on either table had significant orientations of the axes of maximum stiffness. Despite this apparent randomness in orientation, almost all sites exhibited anisotropies equivalent to other parts of the skeleton.

The contribution of the organic matrix to bone's material properties

Bone is a two-phase porous composite material comprised primarily of collagen and mineral, which together provide its mechanical properties. The contribution of the mineral phase to bone's mechanical properties has dominated scientific thinking. Collagen's role has been underappreciated and not very well studied. However, there is evidence that changes in collagen content, or changes to inter- and intrafibrillar collagen cross-linking, can reduce the energy required to cause bone failure (toughness), and increase fracture risk. Although collagen may have less effect on bone's strength and stiffness than does mineral, it may have a profound effect on bone fragility. Collagen changes that occur with age and reduce bone's toughness may be an important factor in the risk of fracture in older women with low bone mass.

Pathogenesis of bone fragility in women and men

There is no one cause of bone fragility; genetic and environmental factors play a part in development of smaller bones, fewer or thinner trabeculae, and thin cortices, all of which result in low peak bone density. Material and structural strength is maintained in early adulthood by remodelling; the focal replacement of old with new bone. However, as age advances less new bone is formed than resorbed in each site remodelled, producing bone loss and structural damage. In women, menopause-related oestrogen deficiency increases remodelling, and at each remodelled site more bone is resorbed and less is formed, accelerating bone loss and causing trabecular thinning and disconnection, cortical thinning and porosity. There is no equivalent midlife event in men, though reduced bone formation and subsequent trabecular and cortical thinning do result in bone loss. Hypogonadism contributes to bone loss in 20-30% of elderly men, and in both sexes hyperparathyroidism secondary to calcium malabsorption increases remodelling, worsening the cortical thinning and porosity and predisposing to hip fractures. Concurrent bone formation on the outer (periosteal) cortical bone surface during ageing partly compensates for bone loss and is greater in men than in women, so internal bone loss is better offset in men. More women than men sustain fractures because their smaller skeleton incurs greater architectural damage and adapts less effectively by periosteal bone formation. The structural basis of bone fragility is determined before birth, takes root during growth, and gains full expression during ageing in both sexes.

Stiff and strong compressive properties are associated with brittle post-yield behavior in equine compact bone material

Our hypothesis was that post-yield mechanical behavior of compact bone material in compression, defined as the stress, strain, or energy absorbed between 0.2% strain-offset and the point of maximum stress, is correlated with material density, modulus, strength, histomorphometric evidence of remodeling, and post-failure gross specimen morphology. Post-yield behavior of compact bone material from the third metacarpal bone of 10 horses, ages 5 months to 20 years, was investigated using single-load compression-to-failure. The post-yield stress, strain, and absorbed energy were compared with the compressive elastic modulus, yield stress, ash density. post-failure macroscopic appearance of the specimen, and histologic evidence of remodeling. High values of elastic modulus, yield stress, and ash density were associated with low values of post-yield mechanical properties (stress, strain, and absorbed energy). Macroscopic post-failure morphology was associated with post-yield mechanical behavior, in that specimens displaying fractures were associated with lower post-yield mechanical properties, and that those without evidence of frank fracture were associated with higher post-yield mechanical properties. Microscopic evidence of remodeling activity was associated with high post-yield mechanical properties, but not with gross post-failure morphology. There was an abrupt change from relatively high values to extremely low values of post-yield mechanical properties at intermediate levels of ash density. This feature may serve as a functional tipper limit to the maximization of bone material stiffness and strength.

The effect of growth/differentiation factor-5 deficiency on femoral composition and mechanical behavior in mice

A subclass of the bone morphogenetic proteins (BMPs), known as growth/differentiation factors (GDFs) 5, 6, and 7, have been shown to affect several skeletal processes, including endochondral ossification, synovial joint formation, and tendon and ligament repair. Mice deficient in GDF-5 have also been shown to exhibit biomechanical abnormalities in tendon that may be associated with altered type I collagen. The purpose of this study was to investigate the effect of GDF-5 deficiency on another type I collagen-rich tissue: cortical bone. Analyses were performed on femora from 8-week-old GDF-5-deficient male brachypodism mice. We hypothesized that GDF-5-deficient bones would exhibit altered geometric, structural, and material properties compared with control littermates. Mutant animals were significantly smaller in body mass than controls (-21%). Geometrically, mutant long bones were significantly shorter (-25%), had a lower polar moment of inertia (-34%), and a lower geometric strength indicator (analogous to the section modulus of a circular section) (-30%). When normalized by body mass, however, geometric differences were no longer significant. Structurally, GDF-5-deficient femora were weaker (-31%) and more compliant (-57%) than controls when tested to failure in torsion. Lower bone structural stiffness in the mutants was not completely explained by the smaller bone geometry, because mutant bones exhibited a significantly lower effective shear modulus (-36%). Although body mass did not fully explain the reduced structural strength in mutant bones, strength differences were adequately explained by bone cross-sectional geometry; maximum effective shear stress was not significantly different between mutants and controls, despite a statistically significant 6% lower ash fraction in mutant femora. No significant difference was detected in collagen content, as indicated by hydroxyproline per dry mass.