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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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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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Lane NE, Nyman JS, Uppuganti S, Chaudhari AJ, Aguirre JI, Shidara K, Liu XP, Yao W, Kimmel DB. Inhibition of vascular endothelial growth factor in young adult mice causes low bone blood flow and bone strength with no effect on bone mass in trabecular regions. Bone Rep 2019; 10:100210. [PMID: 31193542 PMCID: PMC6535464 DOI: 10.1016/j.bonr.2019.100210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/03/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To determine the effect of an antibody to vascular endothelial growth factor (VEGF) on bone blood flow, bone strength, and bone mass in the young adult mouse. Methods Ten-week-old male BALB/cJ mice were body weight-randomized into either a rodent anti-VEGF monoclonal antibody (anti-VEGF, B20-4.1.1; 5 mg/kg 2×/wk.; n = 12) group or a vehicle (VEH; n = 12) group. After 42 days, mice were evaluated for bone blood flow at the distal femur by 18F-NaF-PET/CT and then necropsied. Samples from trabecular and cortical bone regions were evaluated for bone strength by mechanical testing, bone mass by peripheral quantitative computed tomography (pQCT), and micoarchitecture (MicroCT). Hydration of the whole femur was studied by proton nuclear magnetic resonance relaxometry (1H NMR). Results Distal femur blood flow was 43% lower in anti-VEGF mice than in VEH mice (p = 0.009). Ultimate load in the lumbar vertebral body was 25% lower in anti-VEGF than in VEH mice (p = 0.013). Bone mineral density (BMD) in the trabecular region of the proximal humeral metaphysis by pQCT, and bone volume fraction and volumetric BMD by MicroCT were the same in the two groups. Volume fraction of bound water (BW) of the whole femur was 14% lower in anti-VEGF than in VEH mice (p = 0.003). Finally, BW, but not cortical tissue mineral density, helped section modulus explain the variance in the ultimate moment experienced by the femur in three-point bending. Conclusion Anti-VEGF caused low bone blood flow and bone strength in trabecular bone regions without influencing BMD and microarchitecture. Low bone strength was also associated with low bone hydration. These data suggest that bone blood flow is a novel bone property that affects bone quality. An antibody to vascular endothelial growth factor (anti-VEGF) caused low bone blood flow in a trabecular bone rich region. Anti-VEGF did not affect trabecular bone region and bone hydration of the whole femur were also low, trabecular bone mass was not affected by anti-VEGF. Bone blood flow may be a bone property that affects bone quality through bone hydration. Anti-VEGF caused low trabecular bone strength in the vertebral body and low bone hydration of the whole femur.
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Affiliation(s)
- N E Lane
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA 95817, USA
| | - J S Nyman
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - S Uppuganti
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - A J Chaudhari
- Center for Molecular and Genomic Imaging, Department of Radiology, University of California at Davis, Davis, CA 95616, USA
| | - J I Aguirre
- Department of Physiological Sciences, University of Florida, Gainesville, FL 32610, USA
| | - K Shidara
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA 95817, USA
| | - X P Liu
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA 95817, USA
| | - W Yao
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA 95817, USA
| | - D B Kimmel
- Department of Physiological Sciences, University of Florida, Gainesville, FL 32610, USA
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Li H, Shi M, Liu X, Shi Y. Uncertainty optimization of dental implant based on finite element method, global sensitivity analysis and support vector regression. Proc Inst Mech Eng H 2018; 233:232-243. [DOI: 10.1177/0954411918819116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In this work, an uncertainty optimization approach for dental implant is proposed to reduce the stress at implant–bone interface. Finite element method is utilized to calculate the stress at implant–bone interface, and support vector regression is used to replace finite element method to ease the computational cost. Deterministic optimization based on support vector regression is conducted, which demonstrates that the method using support vector regression replacing finite element method in dental implant optimization is efficient and reliable. Global sensitivity analysis based on support vector regression is used to assign different uncertainties (manufacturing errors) to different design variables to save the manufacturing cost. Two popular uncertainty optimization methods, k-sigma method and interval method, are used for the uncertainty optimization of dental implant. The results indicate that the stress at implant–bone interface is reduced greatly considering the uncertainties in design variables with the manufacturing cost increasing a little. This approach can be promoted to other types of bio-implants.
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Affiliation(s)
- Hongyou Li
- College of Mechanical Engineering and Automation, Huaqiao University, Xiamen, China
| | - Maolin Shi
- College of Mechanical Engineering and Automation, Huaqiao University, Xiamen, China
- School of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Xiaomei Liu
- College of Mechanical Engineering and Automation, Huaqiao University, Xiamen, China
| | - Yuying Shi
- College of Mechanical Engineering and Automation, Huaqiao University, Xiamen, China
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Lowe T, Avcu E, Bousser E, Sellers W, Withers PJ. 3D Imaging of Indentation Damage in Bone. MATERIALS (BASEL, SWITZERLAND) 2018; 11:E2533. [PMID: 30551563 PMCID: PMC6316674 DOI: 10.3390/ma11122533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 11/27/2022]
Abstract
Bone is a complex material comprising high stiffness, but brittle, crystalline bio-apatite combined with compliant, but tough, collagen fibres. It can accommodate significant deformation, and the bone microstructure inhibits crack propagation such that micro-cracks can be quickly repaired. Catastrophic failure (bone fracture) is a major cause of morbidity, particularly in aging populations, either through a succession of small fractures or because a traumatic event is sufficiently large to overcome the individual crack blunting/shielding mechanisms. Indentation methods provide a convenient way of characterising the mechanical properties of bone. It is important to be able to visualise the interactions between the bone microstructure and the damage events in three dimensions (3D) to better understand the nature of the damage processes that occur in bone and the relevance of indentation tests in evaluating bone resilience and strength. For the first time, time-lapse laboratory X-ray computed tomography (CT) has been used to establish a time-evolving picture of bone deformation/plasticity and cracking. The sites of both crack initiation and termination as well as the interconnectivity of cracks and pores have been visualised and identified in 2D and 3D.
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Affiliation(s)
- Tristan Lowe
- Henry Moseley X-ray Imaging Facility, Henry Royce Institute, School of Materials, The University of Manchester, Manchester M13 9PL, UK.
| | - Egemen Avcu
- Henry Moseley X-ray Imaging Facility, Henry Royce Institute, School of Materials, The University of Manchester, Manchester M13 9PL, UK.
- Ford Otosan Ihsaniye Automotive Vocational School, Machine and Metal Technologies, Kocaeli University, 41680 Kocaeli, Turkey.
| | - Etienne Bousser
- Henry Moseley X-ray Imaging Facility, Henry Royce Institute, School of Materials, The University of Manchester, Manchester M13 9PL, UK.
- Engineering Physics Department, Polytechnique Montréal, Montreal H3T1J4, QC, Canada.
| | - William Sellers
- School of Earth and Environmental Sciences, The University of Manchester, Manchester M13 9PL, UK.
| | - Philip J Withers
- Henry Moseley X-ray Imaging Facility, Henry Royce Institute, School of Materials, The University of Manchester, Manchester M13 9PL, UK.
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