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Jahani B, Vaidya R, Jin JM, Aboytes DA, Broz KS, Krothapalli S, Pujari B, Baig WM, Tang SY. Assessment of bovine cortical bone fracture behavior using impact microindentation as a surrogate of fracture toughness. JBMR Plus 2024; 8:ziad012. [PMID: 38505533 PMCID: PMC10945719 DOI: 10.1093/jbmrpl/ziad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 03/21/2024] Open
Abstract
The fracture behavior of bone is critically important for evaluating its mechanical competence and ability to resist fractures. Fracture toughness is an intrinsic material property that quantifies a material's ability to withstand crack propagation under controlled conditions. However, properly conducting fracture toughness testing requires the access to calibrated mechanical load frames and the destructive testing of bone samples, and therefore fracture toughness tests are clinically impractical. Impact microindentation mimicks certain aspects of fracture toughness measurements, but its relationship with fracture toughness remains unknown. In this study, we aimed to compare measurements of notched fracture toughness and impact microindentation in fresh and boiled bovine bone. Skeletally mature bovine bone specimens (n = 48) were prepared, and half of them were boiled to denature the organic matrix, while the other half remained preserved in frozen conditions. All samples underwent a notched fracture toughness test to determine their resistance to crack initiation (KIC) and an impact microindentation test using the OsteoProbe to obtain the Bone Material Strength index (BMSi). Boiling the bone samples increased the denatured collagen content, while mineral density and porosity remained unaffected. The boiled bones also showed significant reduction in both KIC (P < .0001) and the average BMSi (P < .0001), leading to impaired resistance of bone to crack propagation. Remarkably, the average BMSi exhibited a high correlation with KIC (r = 0.86; P < .001). A ranked order difference analysis confirmed the excellent agreement between the 2 measures. This study provides the first evidence that impact microindentation could serve as a surrogate measure for bone fracture behavior. The potential of impact microindentation to assess bone fracture resistance with minimal sample disruption could offer valuable insights into bone health without the need for cumbersome testing equipment and sample destruction.
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Affiliation(s)
- Babak Jahani
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - Rachana Vaidya
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - James M Jin
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - Donald A Aboytes
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - Kaitlyn S Broz
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - Siva Krothapalli
- School of Medicine, St Louis University, MO 63104, United States
| | - Bhanuteja Pujari
- School of Medicine, St Louis University, MO 63104, United States
| | - Walee M Baig
- Department of Biology and Environmental Health, Missouri Southern State University, Joplin, MO 64801, United States
| | - Simon Y Tang
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63110, United States
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, United States
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Jahani B, Vaidya R, Jin JM, Aboytes DA, Broz KS, Khrotapalli S, Pujari B, Baig WM, Tang SY. Assessment of bovine cortical bone fracture behavior using impact microindentation as a surrogate of fracture toughness. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.07.552351. [PMID: 37609257 PMCID: PMC10441309 DOI: 10.1101/2023.08.07.552351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
The fracture behavior of bone is critically important for assessing its mechanical competence and ability to resist fractures. Fracture toughness, which quantifies a material's resistance to crack propagation under controlled geometry, is regarded as the gold standard for evaluating a material's resistance to fracture. However properly conducting this test requires access to calibrated mechanical load frames the destruction of the bone samples, making it impractical for obtaining clinical measurement of bone fracture. Impact microindentation offers a potential alternative by mimicking certain aspects of fracture toughness measurements, but its relationship with mechanistic fracture toughness remains unknown. In this study, we aimed to compare measurements of notched fracture toughness and impact microindentation in fresh and boiled bovine bone. Skeletally mature bovine bone specimens (n=48) were prepared, and half of them were boiled to denature the organic matrix, while the other half remained preserved in frozen conditions. Notched fracture toughness tests were conducted on all samples to determine Initiation toughness (KIC), and an impact microindentation test using the OsteoProbe was performed to obtain the Bone Material Strength index. Boiling the bone samples resulted increased the denatured collagen without affecting mineral density or porosity. The boiled bones also showed significant reduction in both KIC (p < 0.0001) and the average Bone Material Strength index (p < 0.0001), leading to impaired resistance of bone to crack propagation. Remarkably, the average Bone Material Strength index exhibited a high correlation with KIC (r = 0.86; p < 0.001). The ranked order difference analysis confirmed excellent agreement between the two measures. This study provides the first evidence that impact microindentation could serve as a surrogate measure for bone fracture behavior. The potential of impact microindentation to non-destructively assess bone fracture resistance could offer valuable insights into bone health without the need for elaborate testing equipment and sample destruction.
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Affiliation(s)
- Babak Jahani
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachana Vaidya
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - James M. Jin
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Donald A. Aboytes
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kaitlyn S. Broz
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | | | | | - Simon Y. Tang
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, Missouri, USA
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Porwal K, Sharma S, Kumar S, Tomar MS, Sadhukhan S, Rajput S, Kulkarni C, Shrivastava A, Kumar N, Chattopadhyay N. Hormonal and non-hormonal oral contraceptives given long-term to pubertal rats differently affect bone mass, quality and metabolism. Front Endocrinol (Lausanne) 2023; 14:1233613. [PMID: 37664835 PMCID: PMC10470083 DOI: 10.3389/fendo.2023.1233613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction We investigated the effects of hormonal and non-hormonal oral contraceptives (OCs) on bone mass, mineralization, composition, mechanical properties, and metabolites in pubertal female SD rats. Methods OCs were given for 3-, and 7 months at human equivalent doses. The combined hormonal contraceptive (CHC) was ethinyl estradiol and progestin, whereas the non-hormonal contraceptive (NHC) was ormeloxifene. MicroCT was used to assess bone microarchitecture and BMD. Bone formation and mineralization were assessed by static and dynamic histomorphometry. The 3-point bending test, nanoindentation, FTIR, and cyclic reference point indentation (cRPI) measured the changes in bone strength and material composition. Bone and serum metabolomes were studied to identify potential biomarkers of drug efficacy and safety and gain insight into the underlying mechanisms of action of the OCs. Results NHC increased bone mass in the femur metaphysis after 3 months, but the gain was lost after 7 months. After 7 months, both OCs decreased bone mass and deteriorated trabecular microarchitecture in the femur metaphysis and lumbar spine. Also, both OCs decreased the mineral: matrix ratio and increased the unmineralized matrix after 7 months. After 3 months, the OCs increased carbonate: phosphate and carbonate: amide I ratios, indicating a disordered hydroxyapatite crystal structure susceptible to resorption, but these changes mostly reversed after 7 months, indicating that the early changes contributed to demineralization at the later time. In the femur 3-point bending test, CHC reduced energy storage, resilience, and ultimate stress, indicating increased susceptibility to micro-damage and fracture, while NHC only decreased energy storage. In the cyclic loading test, both OCs decreased creep indentation distance, but CHC increased the average unloading slope, implying decreased microdamage risk and improved deformation resistance by the OCs. Thus, reduced bone mineralization by the OCs appears to affect bone mechanical properties under static loading, but not its cyclic loading ability. When compared to an age-matched control, after 7 months, CHC affected 24 metabolic pathways in bone and 9 in serum, whereas NHC altered 17 in bone and none in serum. 6 metabolites were common between the serum and bone of CHC rats, suggesting their potential as biomarkers of bone health in women taking CHC. Conclusion Both OCs have adverse effects on various skeletal parameters, with CHC having a greater negative impact on bone strength.
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Affiliation(s)
- Konica Porwal
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
| | - Shivani Sharma
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
- Academy of Scientifc and Innovative Research (AcSIR), Ghaziabad, India
| | - Saroj Kumar
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
| | | | - Sreyanko Sadhukhan
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
- Academy of Scientifc and Innovative Research (AcSIR), Ghaziabad, India
| | - Swati Rajput
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
- Academy of Scientifc and Innovative Research (AcSIR), Ghaziabad, India
| | - Chirag Kulkarni
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
- Academy of Scientifc and Innovative Research (AcSIR), Ghaziabad, India
| | | | - Navin Kumar
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
| | - Naibedya Chattopadhyay
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
- Academy of Scientifc and Innovative Research (AcSIR), Ghaziabad, India
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Uniyal P, Sharma A, Kumar N. Investigation on the sensitivity of indentation devices for detection of fatigue loading induced damage in bovine cortical bone. J Biomech 2022; 143:111274. [PMID: 36049386 DOI: 10.1016/j.jbiomech.2022.111274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 10/15/2022]
Abstract
Daily physiological activities subject our skeletal system to cyclic loading with varying frequencies and magnitudes. These loadings interact with the microstructure of bone and create microdamage, which can cause stress-induced injuries if not repaired on the time. The early detection is required to prevent the complications associated with these fractures. In the present study, to examine fatigue loading-induced damage in cortical bone, the sensitivity of four different indentation devices was investigated. For this, cortical bone samples were fatigued in four-point bending configuration at 0.5 Hz, 2 Hz and 4 Hz frequencies. Following the fatigue loading, cyclic reference point indentation (cRPI), impact reference point indentation (iRPI), Vickers microhardness and nanoindentation tests were performed on the bone samples. Results show that indentation devices are sensitive to detect fatigue loading induced damage only in 0.5 Hz group samples on compressive region. On the other hand, the sensitivity of indentation devices for tensile stress-induced damage is not clear. Also, histological examination of fatigued bone samples shows a significant increase in the crack density and crack length with fatigue loading only for the 0.5 Hz group samples. The present study provides insight into the sensitivity of different indentation devices to fatigue loading induced damage, which could be helpful in the development of new devices for the early diagnosis of stress induced injuries.
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Affiliation(s)
- Piyush Uniyal
- Department of Biomedical Engineering, IIT Ropar, India
| | - Akshay Sharma
- Department of Mechanical Engineering, IIT Ropar, India
| | - Navin Kumar
- Department of Biomedical Engineering, IIT Ropar, India; Department of Mechanical Engineering, IIT Ropar, India.
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Lee DH, Reasoner K, Uppuganti S, Desai MJ, Nyman JS. Intraoperative use of impact microindentation to assess distal radius bone quality. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2022; 93:064102. [PMID: 35778010 DOI: 10.1063/5.0082751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Impact microindentation is a new technique that measures the resistance of a patient's bone to micro-indentation but has not yet been implemented in an intraoperative setting. To assess the technique's safety and utility, we acquired microindentation measurements of bone material strength index (BMSi) using the OsteoProbe prior to distal radius fixation with a volar locking plate. Subsequently, the patients received a dual-energy x-ray absorptiometry scan to measure the areal bone mineral density of the proximal femur, lumbar spine, and contralateral distal radius. By assigning the patients to low-energy, fragility fracture (n = 17) and high-energy fracture (n = 11) groups based on clinical history, we investigated whether intraoperative BMSi was sensitive to osteoporosis. Impact microindentation added a maximum of 10 min of operative time and did not result in any intraoperative or postoperative complications. There were, however, no significant differences in BMSi at the radius between these two groups. This study demonstrates the feasibility of performing intraoperative impact microindentation to directly assess a patient's bone quality, but additional research is necessary to establish whether intraoperative microindentation can identify patients with inferior bone matrix quality.
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Affiliation(s)
- Donald H Lee
- Vanderbilt Orthopaedic Institute and the Department of Orthopaedic Surgery Hand and Upper Extremity Center, Vanderbilt University Medical Center, Medical Center East, South Tower Suite 3200, 1215 21 Avenue South, Nashville, Tennessee 37232, USA
| | - Kaitlyn Reasoner
- Department of Internal Medicine, Vanderbilt University Medical Center, D-3100 Medical Center North, 1161 21 Avenue South, Nashville, Tennessee 37232, USA
| | - Sasidhar Uppuganti
- Vanderbilt Orthopaedic Institute and the Department of Orthopaedic Surgery Hand and Upper Extremity Center, Vanderbilt University Medical Center, Medical Center East, South Tower Suite 3200, 1215 21 Avenue South, Nashville, Tennessee 37232, USA
| | - Mihir J Desai
- Vanderbilt Orthopaedic Institute and the Department of Orthopaedic Surgery Hand and Upper Extremity Center, Vanderbilt University Medical Center, Medical Center East, South Tower Suite 3200, 1215 21 Avenue South, Nashville, Tennessee 37232, USA
| | - Jeffry S Nyman
- Vanderbilt Orthopaedic Institute and the Department of Orthopaedic Surgery Hand and Upper Extremity Center, Vanderbilt University Medical Center, Medical Center East, South Tower Suite 3200, 1215 21 Avenue South, Nashville, Tennessee 37232, USA
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Reeves JM, Vanasse T, Roche C, Faber KJ, Langohr GDG. Initial Assessments of a Handheld Indentation Probe's Correlation With Cancellous Bone Density, Stiffness, and Strength: An Objective Alternative to “Thumb Testing”. J Med Device 2021. [DOI: 10.1115/1.4052305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Objective: During shoulder arthroplasty, surgeons must select the optimal implant for each patient. The metaphyseal bone properties affect this decision; however, the typical resection “thumb test” lacks objectivity. This investigation's purposes were to determine the correlation strength between the indentation depth of a handheld mechanism and the density, compressive strength, and modulus of a bone surrogate; as well as to assess how changing the indenter tip shape and impact energy may affect the correlation strengths. Methods: A spring-loaded indenter was developed. Four tip shapes (needle, tapered, flat, and radiused cylinders) and four spring energies (0.13 J–0.76J) were assessed by indenting five cellular foam bone surrogates of varying density, every five times. After each indentation, the indentation depth was measured with a separate probe and correlated with manufacturer specifications of the apparent density, compressive strength, and modulus. Results: indentation depth plateaued as the bone surrogate's material properties increased, particularly for indentation tips with larger footprints and the 0.13 J spring. All tip shapes produced strong (R2≥0.7) power-law relationships between the indentation depth metric and the bone surrogate's material properties (density: 0.70 ≤ R2 ≤ 0.95, strength: 0.75 ≤ R2 ≤ 0.97, modulus: 0.70 ≤ R2 ≤ 0.93); though the use of the needle tip yielded the widest indentation depth scale. Interpretation: these strong correlations suggest that a handheld indenter may provide objective intra-operative evidence of cancellous material properties. Further investigations are warranted to study indenter tip shape and spring energy in human tissue; though the needle tip with spring energy between 0.30 J and 0.76 J seems the most promising.
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Affiliation(s)
- Jacob M. Reeves
- Department of Mechanical and Materials Engineering, The University of Western Ontario, London, ON N6A 3K7, Canada
| | | | | | - Kenneth J. Faber
- Roth
- McFarlane Hand and Upper Limb Centre, London, ON N6A 4V2, Canada
| | - G. Daniel G. Langohr
- Department of Mechanical and Materials Engineering, The University of Western Ontario, London, ON N6A 3K7, Canada
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Rokidi S, Bravenboer N, Gamsjaeger S, Chavassieux P, Zwerina J, Paschalis E, Papapoulos S, Appelman-Dijkstra N. Impact microindentation measurements correlate with cortical bone material properties measured by Fourier transform infrared imaging in humans. Bone 2020; 137:115437. [PMID: 32473316 DOI: 10.1016/j.bone.2020.115437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 11/27/2022]
Abstract
Bone Material Strength index (BMSi) measured by Impact Microindentation is generally lower in subjects with fragility fractures independently of BMD values. We recently reported that in humans, BMSi values are strongly associated with material properties of subperiosteal mineralized bone surface (local mineral content, nanoporosity, pyridinoline content). In the present study we investigated the relationship of BMSi with material properties of the whole bone cortex, by analyzing thin sections of iliac crest biopsies (N = 12) from patients with different skeletal disorders and a wide range of BMD with or without fractures, by Fourier transform infrared imaging (FTIRI). The calculated parameters were: i) mineral and organic matrix content and their ratio (MM), ii) mineral maturity/crystallinity (MMC) and iii) the ratio of pyridinoline (Pyd) and divalent collagen cross-links (XLR). Results were expressed as images, which were converted to histogram distributions. For each histogram the characteristics recorded were: mean value, mode (most often occurring value), skewness, and kurtosis and their association with BMSi values was examined by correlation analysis. BMSi values were significantly correlated only with MM mean and mode values (r = 0.736, p = 0.0063, and r = 0.855, p = 0.0004, respectively), and with XLR mode values (r = -0.632, p = 0.0274). The results of the present study demonstrate that BMSi values are strongly associated with MM, a metric that corrects the mineral content for the organic matrix content, and may also depend on organic matrix quality. These and our previous observations strongly suggest that BMSi assesses material properties of cortical bone.
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Affiliation(s)
- Stamatia Rokidi
- Ludwig Boltzmann Institute of Osteology at 1st Medical Department, Hanusch Hospital of Österreichische Gesundheitskasse (ÖGK) and Research Funds of the Austrian Workers Compensation Board (AUVA) Trauma Centre Meidling, Vienna, Austria
| | - Natalie Bravenboer
- Leiden Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
| | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at 1st Medical Department, Hanusch Hospital of Österreichische Gesundheitskasse (ÖGK) and Research Funds of the Austrian Workers Compensation Board (AUVA) Trauma Centre Meidling, Vienna, Austria
| | | | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at 1st Medical Department, Hanusch Hospital of Österreichische Gesundheitskasse (ÖGK) and Research Funds of the Austrian Workers Compensation Board (AUVA) Trauma Centre Meidling, Vienna, Austria
| | - Eleftherios Paschalis
- Ludwig Boltzmann Institute of Osteology at 1st Medical Department, Hanusch Hospital of Österreichische Gesundheitskasse (ÖGK) and Research Funds of the Austrian Workers Compensation Board (AUVA) Trauma Centre Meidling, Vienna, Austria.
| | - Socrates Papapoulos
- Leiden Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
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Orduna G, Mellibovsky L, Abella E, Nogués X, Granero R, García-Giralt N, Pineda-Moncusí M, Güerri-Fernández R, Prieto-Alhambra D, Díez-Pérez A. Bone tissue quality in patients with monoclonal gammopathy of uncertain significance. J Bone Miner Metab 2020; 38:563-569. [PMID: 31974675 DOI: 10.1007/s00774-020-01084-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/06/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Monoclonal gammopathy of uncertain significance (MGUS) is highly prevalent in older adults and affects bone structure, with osteoporosis and increased risk of fractures in up to 14% of affected patients. Dual-energy X-ray absorptiometry (DXA), the standard technique for diagnosing osteoporosis, is ineffective to reveal microstructure and bone quality in this disease. MATERIALS AND METHODS We conducted a cross-sectional study of patients with MGUS, recruited consecutively from the Hematology and Internal Medicine Departments of Hospital del Mar, Barcelona, between January 2011 and January 2018. Medical records, clinical results and spinal X-ray images were collected. Bone mineral density (BMD) at hip and spine was measured by DXA and Bone Material Strength index (BMSi) by impact microindentation on the tibial mid-shaft. RESULTS Thirty-nine patients with MGUS and 65 age-matched controls without previous fractures were included. In the MGUS group, 11 (28.2%) patients had prevalent fractures, nearly half of them vertebral (n = 5, 45.45%). Compared to controls, MGUS patients had significantly lower BMSi, a mean (SD) of 70.72 (9.70) vs. 78.29 (8.70), p = 0.001, and lower spinal BMD values (0.900 [0.159] vs. 1.003 [0.168], respectively, p = 0.012), but no significant differences at femoral neck and total hip. No association was observed between BMSi and DXA. Bone remodeling markers (procollagen type-1 N propeptide, bone-alkaline phosphatase and C-terminal telopeptide of type I collagen) did not differ between the two groups. CONCLUSIONS Spinal BMD and mechanical properties of bone tissue, as measured by impact microindentation, were impaired in patients with MGUS. These changes in bone tissue mechanical resistance were independent of DXA levels.
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Affiliation(s)
- Guillermina Orduna
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Leonardo Mellibovsky
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Eugenia Abella
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Xavier Nogués
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain.
| | - Roser Granero
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain
| | - Natalia García-Giralt
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Marta Pineda-Moncusí
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Roberto Güerri-Fernández
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom, and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Adolfo Díez-Pérez
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
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Merlo K, Aaronson J, Vaidya R, Rezaee T, Chalivendra V, Karim L. In Vitro-Induced High Sugar Environments Deteriorate Human Cortical Bone Elastic Modulus and Fracture Toughness. J Orthop Res 2020; 38:972-983. [PMID: 31793028 PMCID: PMC7162721 DOI: 10.1002/jor.24543] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/24/2019] [Indexed: 02/04/2023]
Abstract
Advanced glycation end-products (AGEs) have been suggested to contribute to bone fragility in type 2 diabetes (T2D). AGEs can be induced through in vitro sugar incubations but there is limited data on the effect of total fluorescent AGEs on mechanical properties of human cortical bone, which may have altered characteristics in T2D. Thus, to examine the effect of AGEs on bone directly in T2D patients with uncontrolled sugar levels, it is essential to first understand the fundamental mechanisms by studying the effects of controlled in vitro-induced AGEs on cortical bone mechanical behavior. Here, human cortical bone specimens from female cadaveric tibias (ages 57-87) were incubated in an in vitro 0.6 M ribose or vehicle solution (n = 20/group) for 10 days at 37°C, their mechanical properties were assessed by microindentation and fracture toughness tests, and induced AGE levels were quantified through a fluorometric assay. Results indicated that ribose-incubated bone had significantly more AGEs (+81%, p ≤ 0.005), lower elastic modulus assessed by traditional microindentation, and lower fracture toughness compared with vehicle controls. Furthermore, based on pooled data, increased AGEs were significantly correlated with deteriorated mechanical properties. The findings presented here show that the accumulation of AGEs allows for lower stiffness and increased ability to initiate a crack in human cortical bone. Statement of clinical significance: High sugar levels as in T2D results in deteriorated bone quality via AGE accumulation with a consequent weakening in bone's mechanical integrity. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:972-983, 2020.
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Affiliation(s)
- Kelly Merlo
- Department of Mechanical Engineering, University of Massachusetts Dartmouth, 285 Old Westport Road, Dartmouth, MA 02747, USA
| | - Jacob Aaronson
- Department of Bioengineering, University of Massachusetts Dartmouth, 285 Old Westport Road, Dartmouth, MA 02747, USA
| | - Rachana Vaidya
- Department of Bioengineering, University of Massachusetts Dartmouth, 285 Old Westport Road, Dartmouth, MA 02747, USA
| | - Taraneh Rezaee
- Department of Bioengineering, University of Massachusetts Dartmouth, 285 Old Westport Road, Dartmouth, MA 02747, USA
| | - Vijaya Chalivendra
- Department of Mechanical Engineering, University of Massachusetts Dartmouth, 285 Old Westport Road, Dartmouth, MA 02747, USA
| | - Lamya Karim
- Department of Bioengineering, University of Massachusetts Dartmouth, 285 Old Westport Road, Dartmouth, MA 02747, USA
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Starr JR, Tabacco G, Majeed R, Omeragic B, Bandeira L, Rubin MR. PTH and bone material strength in hypoparathyroidism as measured by impact microindentation. Osteoporos Int 2020; 31:327-333. [PMID: 31720712 DOI: 10.1007/s00198-019-05177-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
UNLABELLED PTH levels might be associated with bone material strength as measured by impact microindentation. Resistance to microfracture is decreased in hypoparathyroidism and appears to be associated with more severe disease and to improve with PTH replacement. INTRODUCTION PTH is a key regulator of bone structure and remodeling. When PTH is absent in hypoparathyroidism (HypoPT), bone mass is increased and remodeling is decreased. In addition to bone structure and remodeling, bone material properties contribute to fracture resistance. Yet little is known about the relationship between PTH and bone material properties. Impact microindentation provides a clinical assessment of microfracture resistance, measured as the bone material strength index (BMSi). METHODS Case-control cross-sectional study of PTH levels and in vivo BMSi measurement by impact microindentation at the anterior tibia in HypoPT patients (n = 17) and in controls matched for age, sex, and menopausal status (n = 17), with follow-up in a subgroup of HypoPT patients (n = 5) after recombinant human parathyroid hormone (1-84) [rhPTH(1-84)] treatment. RESULTS BMSi was positively associated with PTH levels in controls (r = 0.58, p = 0.02) and was 11% lower (p = 0.01) in HypoPT patients as compared with controls. In HypoPT, lower BMSi was associated with a trend toward greater supplemental calcium doses (p = 0.07). BMSi increased after rhPTH(1-84) treatment in the HypoPT patients who underwent repeat microindentation. CONCLUSIONS PTH levels might be associated with bone material strength, although other factors might be contributory. In HypoPT, resistance to microfracture is decreased and may be associated with greater supplemental calcium doses and might increase with PTH replacement. It remains to be determined whether changes in bone remodeling and microarchitecture contribute to the effects of PTH on microfracture resistance.
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Affiliation(s)
- J R Starr
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, 630 W. 168th St., PH8W-864, New York, NY, 10032, USA
| | - G Tabacco
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, 630 W. 168th St., PH8W-864, New York, NY, 10032, USA
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - R Majeed
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, 630 W. 168th St., PH8W-864, New York, NY, 10032, USA
| | - B Omeragic
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, 630 W. 168th St., PH8W-864, New York, NY, 10032, USA
| | - L Bandeira
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, 630 W. 168th St., PH8W-864, New York, NY, 10032, USA
- Fleury Group, Sao Paulo, SP, Brazil
| | - M R Rubin
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, 630 W. 168th St., PH8W-864, New York, NY, 10032, USA.
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11
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Schoeb M, Hamdy NAT, Malgo F, Winter EM, Appelman-Dijkstra NM. Added Value of Impact Microindentation in the Evaluation of Bone Fragility: A Systematic Review of the Literature. Front Endocrinol (Lausanne) 2020; 11:15. [PMID: 32117052 PMCID: PMC7020781 DOI: 10.3389/fendo.2020.00015] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/09/2020] [Indexed: 12/22/2022] Open
Abstract
The current gold standard for the diagnosis of osteoporosis and the prediction of fracture risk is the measurement of bone mineral density (BMD) using dual energy x-ray absorptiometry (DXA). A low BMD is clearly associated with increased fracture risk, but BMD is not the only determinant of bone strength, particularly in secondary osteoporosis and metabolic bone disorders in which components other than BMD are affected and DXA often underestimates true fracture risk. Material properties of bone which significantly contribute to bone strength have become evaluable in vivo with the impact microindentation (IMI) technique using the OsteoProbe® device. The question arises whether this new tool is of added value in the evaluation of bone fragility. To this effect, we conducted a systematic review of all clinical studies using IMI in vivo in humans also addressing practical aspects of the technique and differences in study design, which may impact outcome. Search data generated 38 studies showing that IMI can identify patients with primary osteoporosis and fractures, patients with secondary osteoporosis due to various underlying systemic disorders, and scarce longitudinal data also show that this tool can detect changes in bone material strength index (BMSi), following bone-modifying therapy including use of corticosteroids. However, this main outcome parameter was not always concordant between studies. This systematic review also identified a number of factors that impact on BMSi outcome. These include subject- and disease-related factors such as the relationship between BMSi and age, geographical region and the presence of fractures, and technique- and operator-related factors. Taken together, findings from this systematic review confirm the added value of IMI for the evaluation and follow-up of elements of bone fragility, particularly in secondary osteoporosis. Notwithstanding, the high variability of BMSi outcome between studies calls for age-dependent reference values, and for the harmonization of study protocols. Prospective multicenter trials using standard operating procedures are required to establish the value of IMI in the prediction of future fracture risk, before this technique is introduced in routine clinical practice.
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Dawson-Hughes B, Bouxsein M, Shea K. Bone material strength in normoglycemic and hyperglycemic black and white older adults. Osteoporos Int 2019; 30:2429-2435. [PMID: 31463589 PMCID: PMC6879849 DOI: 10.1007/s00198-019-05140-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/12/2019] [Indexed: 12/31/2022]
Abstract
This cross-sectional study assessed cortical bone properties via impact microindentation in adults with normoglycemia, prediabetes, and early-stage T2D. Bone material strength index was stable across the glycemia categories in whites but it declined in blacks. Blacks may be more susceptible than whites to impaired cortical bone properties in early diabetes. INTRODUCTION Individuals with long-standing type 2 diabetes (T2D) have altered cortical bone material properties as determined by impact microindentation. This cross-sectional study was done to determine whether altered cortical bone material properties could be detected in adults with prediabetes or early-stage T2D. METHODS Men and postmenopausal women aged ≥ 50 years with no diabetes (50 white, 6 black), prediabetes (75 white, 13 black), and T2D of ≤ 5 years duration (24 white and 16 black) had assessments of bone material strength index (BMSi) by impact microindentation, trabecular bone score (TBS), and bone mineral density (BMD) by DXA and the advanced glycation end product, urine pentosidine. RESULTS The association between glycemia category and BMSi differed by race (interaction p = 0.037). In the whites, BMSi did not differ across the glycemia categories, after adjustment for age, sex, and BMI (no diabetes 76.3 ± 1.6 (SEM), prediabetes 77.2 ± 1.3, T2D 76.2 ± 2.5, ANCOVA p = 0.887). In contrast, in the blacks, BMSi differed (ANCOVA p = 0.020) and was significantly lower in subjects with T2D than in those with prediabetes (p < 0.05) and no diabetes (p < 0.05) (mean ± SEM BMSi in no diabetes 86.0 ± 4.3, prediabetes 91.0 ± 3.2, and T2D 71.6 ± 2.9). Neither TBS nor urine pentosidine differed significantly across the glycemia categories in either whites or blacks. CONCLUSIONS These findings suggest different associations of glycemia with cortical bone material properties in blacks and whites, with blacks possibly being more susceptible to impaired cortical bone properties than whites in early diabetes. A larger study is needed to verify these observations.
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Affiliation(s)
- B Dawson-Hughes
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.
| | - M Bouxsein
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - K Shea
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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13
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Modeling of Osteoprobe indentation on bone. J Mech Behav Biomed Mater 2019; 90:365-373. [DOI: 10.1016/j.jmbbm.2018.09.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/02/2018] [Accepted: 09/24/2018] [Indexed: 12/27/2022]
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14
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Popp KL, Caksa S, Martinez-Betancourt A, Yuan A, Tsai J, Yu EW, Bouxsein ML. Cortical Bone Material Strength Index and Bone Microarchitecture in Postmenopausal Women With Atypical Femoral Fractures. J Bone Miner Res 2019; 34:75-82. [PMID: 30281863 DOI: 10.1002/jbmr.3590] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 01/19/2023]
Abstract
Atypical femoral fractures are rare fractures that occur in the subtrochanteric or diaphyseal region of the femur with minimal or no trauma. Though the association of atypical femoral fractures (AFFs) and bisphosphonate (BP) use is a growing concern in the management of osteoporosis, currently there is little knowledge about which patients may be at risk for an atypical femoral fracture. Given that these fractures initiate in the femoral cortex, we aimed to determine whether cortical bone tissue properties (bone material strength index; BMSi), as measured by in vivo impact microindentation, are altered in atypical fracture patients. We also aimed to identify factors associated with the BMSi measurements. We enrolled postmenopausal women with recent AFFs (n = 15) or hip fractures (Hip Fxs; n = 20), long-term (>5 years) BP users (n = 30), and treatment naïve controls (n = 88). We measured total hip and femoral neck BMD by DXA, cortical bone microstructure at the distal tibia by HR-pQCT, and BMSi at the midtibia by impact microindentation. BMSi values were similar in all groups, with no effects of long-term BP use or lower values in patients with AFFs or Hip Fxs, even after multivariable adjustment. BMSi measurements were independent of age, femoral BMD, duration of BP treatment, vitamin D level, and cortical bone microstructure, including cortical porosity and cortical tissue mineral density. In conclusion, impact microindentation values are not negatively affected by long-term BP use and do not appear to discriminate individuals who suffer AFFs. Thus, our results do not support clinical use of impact microindentation to identify those at risk for AFFs. This remains to be verified in larger studies. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, THR-1051, Boston, MA USA
| | - Signe Caksa
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA USA
| | | | - Amy Yuan
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA USA
| | - Joy Tsai
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, THR-1051, Boston, MA USA
| | - Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, THR-1051, Boston, MA USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, THR-1051, Boston, MA USA.,Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, and Department of Orthopedic Surgery, Harvard Medical School, One Overland Street, Boston, MA USA
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15
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Chang A, Easson GW, Tang SY. Clinical measurements of bone tissue mechanical behavior using reference point indentation. Clin Rev Bone Miner Metab 2018; 16:87-94. [PMID: 30983912 DOI: 10.1007/s12018-018-9249-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last thirty years, it has become increasingly clear the amount of bone (e.g. 'bone quantity') and the quality of the bone matrix (e.g. 'bone quality') both critically contribute to bone's tissue-level mechanical behavior and the subsequent ability of bone to resist fracture. Although determining the tissue-level mechanical behavior of bone through mechanical testing is relatively straightforward in the laboratory, the destructive nature of such testing is unfeasible in humans and in animal models requiring longitudinal observation. Therefore, surrogate measurements are necessary for quantifying tissue-level mechanical behavior for the pre-clinical and clinical evaluation of bone strength and fracture risk in vivo. A specific implementation of indentation known as reference point indentation (RPI) enables the mechanical testing of bone tissue without the need to excise and prepare the bone surface. However, this compromises the ability to carefully control the specimen geometry that is required to define the bone tissue material properties. Yet the versatility of such measurements in clinical populations is provocative, and to date there are a number of promising studies that have utilized this tool to discern bone pathologies and to monitor the effects of therapeutics on bone quality. Concurrently, on-going efforts continue to investigate the aspects of bone material behavior measured by RPI, and the compositional factors that contribute to these measurements. There are currently two variants, cyclic- and impact- RPI, that have been utilized in pre-clinical and clinical studies. This review surveys clinical studies that utilize RPI, with particular emphasis on the clinical instrument, as well as the endeavors to understand the fundamental mechanisms of such measurements. Ultimately, an improved awareness in the tradeoffs and limitations of in vivo RPI is critical towards the effective and successful utilization of this tool for the overall improvement of fragility determination in the clinic.
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Affiliation(s)
- Andrew Chang
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
| | - Garrett W Easson
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
| | - Simon Y Tang
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
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16
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Rozental TD, Walley KC, Demissie S, Caksa S, Martinez-Betancourt A, Parker AM, Tsai JN, Yu EW, Bouxsein ML. Bone Material Strength Index as Measured by Impact Microindentation in Postmenopausal Women With Distal Radius and Hip Fractures. J Bone Miner Res 2018; 33:621-626. [PMID: 29115684 DOI: 10.1002/jbmr.3338] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/02/2017] [Accepted: 11/07/2017] [Indexed: 01/17/2023]
Abstract
We tested whether cortical bone tissue properties assessed by in vivo impact microindentation would distinguish postmenopausal women with recent distal radius (DRF) or hip fracture (HF) from nonfracture controls (CONT). We enrolled postmenopausal women with recent DRF (n = 57), HF (n = 41), or CONT (n = 93), and used impact microindentation to assess bone material strength index (BMSi) at the anterior surface of the mid-tibia diaphysis. Areal bone mineral density (aBMD) (g/cm2 ) of the femoral neck (FN), total hip (TH), and lumbar spine (LS) were measured by dual-energy X-ray absorptiometry (DXA). HF and DRF subjects had significantly lower BMD than CONT at all sites (-5.6% to -8.2%, p < 0.001 for all). BMSi was 4% lower in DRF compared to CONT (74.36 ± 8.77 versus 77.41 ± 8.79, p = 0.04). BMSi was similarly lower in HF versus CONT, but the difference did not reach statistical significance (74.62 ± 8.47 versus 77.41 ± 8.79, p = 0.09). Lower BMSi was associated with increased risk of DRF (unadjusted OR, 1.43; 95% CI, 1.02 to 2.00, per SD decrease, p = 0.04), and remained statistically significant after adjustment for age, age and BMI, and age, BMI, and FN BMD (OR = 1.48 to 1.55). Lower BMSi tended to be associated with HF, but only reached borderline significance (unadjusted OR = 1.39; 95% CI, 0.96 to 2.01, p = 0.08). These results provide strong rationale for future investigations aimed at assessing whether BMSi can predict fracture in prospective studies and improve identification of women at risk for fragility fractures. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Tamara D Rozental
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Kempland C Walley
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Serkalem Demissie
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Signe Caksa
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Amber M Parker
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joy N Tsai
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mary L Bouxsein
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA.,Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
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17
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McAndrew CM, Agarwalla A, Abraham AC, Feuchtbaum E, Ricci WM, Tang SY. Local bone quality measurements correlates with maximum screw torque at the femoral diaphysis. Clin Biomech (Bristol, Avon) 2018; 52:95-99. [PMID: 29407864 PMCID: PMC5835210 DOI: 10.1016/j.clinbiomech.2018.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/17/2018] [Accepted: 01/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Successful fracture fixation depends critically on the stability of the screw-bone interface. Maximum achievable screw torque reflects the competence of this interface, but it cannot be quantified prior to screw stripping. Typically, the surgeon relies on the patients' bone mineral density and radiographs, along with experience and tactile feedback to assess whether sufficient compression can be generated by the screw and bone. However, the local bone quality would also critically influence the strength of the bone-screw interface. We investigated whether Reference Point Indentation can provide quantitative local bone quality measures that can inform subsequent screw-bone competence. METHODS We examined the associations between the maximum screw torque that can be achieved using 3.5 mm, 4.5 mm, and 6.5 mm diameter stainless steel screws at the distal femoral metaphysis and mid-diaphysis from 20 cadavers, with the femoral neck bone mineral density and the local measures of bone quality using Reference Point Indentation. FINDINGS Indentation Distance Increase, a measure of bone's resistance to microfracture, correlated with the maximum screw stripping torque for the 3.5 mm (p < 0.01; R = 0.56) and 4.5 mm diameter stainless steel screws (p < 0.01; R = 0.57) at the femoral diaphysis. At the femoral metaphysis, femoral neck bone mineral density significantly correlated with the maximum screw stripping torque achieved by the 3.5 mm (p < 0.01; R = 0.61), 4.5 mm (p < 0.01; R = 0.51), and 6.5 mm diameter stainless steel screws (p < 0.01; R = 0.56). INTERPRETATION Reference Point Indentation can provide localized measurements of bone quality that may better inform surgeons of the competence of the bone-implant interface and improve effectiveness of fixation strategies particularly in patients with compromised bone quality.
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Affiliation(s)
| | - Avinesh Agarwalla
- Department of Biomedical Engineering, Washington University in St. Louis, MO, USA
| | - Adam C Abraham
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
| | - Eric Feuchtbaum
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
| | - William M Ricci
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
| | - Simon Y Tang
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA; Department of Biomedical Engineering, Washington University in St. Louis, MO, USA; Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, MO, USA.
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