Osteoporosis and Covid-19: Detected similarities in bone lacunar-level alterations via combined AI and advanced synchrotron testing

While advanced imaging strategies have improved the diagnosis of bone-related pathologies, early signs of bone alterations remain difficult to detect. The Covid-19 pandemic has brought attention to the need for a better understanding of bone micro-scale toughening and weakening phenomena. This study used an artificial intelligence-based tool to automatically investigate and validate four clinical hypotheses by examining osteocyte lacunae on a large scale with synchrotron image-guided failure assessment. The findings indicate that trabecular bone features exhibit intrinsic variability related to external loading, micro-scale bone characteristics affect fracture initiation and propagation, osteoporosis signs can be detected at the micro-scale through changes in osteocyte lacunar features, and Covid-19 worsens micro-scale porosities in a statistically significant manner similar to the osteoporotic condition. Incorporating these findings with existing clinical and diagnostic tools could prevent micro-scale damages from progressing into critical fractures.

The effect of morphometric and geometric indices of the human calvarium on mechanical response

BACKGROUND

When developing a surrogate model of the human skull, there is a multitude of morphometric and geometric properties to consider when constructing the model. To simplify this approach, it is important to identify only the properties that have a significant influence on the mechanical response of the skull. The objective of this study was to identify which morphometric and geometric properties of the calvarium were significant predictors of mechanical response.

METHODS

Calvarium specimens (N = 24) were micro-computed tomography scanned to determine morphometric and geometric properties. The specimens were assumed to be Euler-Bernoulli beams and were subject to 4-point quasi-static bending to determine mechanical response. Univariate linear regressions were performed whereby the morphometric and geometric properties were independent or predictor variables and the mechanical responses were dependent or outcome variables.

FINDINGS

Nine significant linear regression models were established (p < 0.05). In the diploë, trabecular bone pattern factor was a significant predictor of force and bending moment at fracture. The inner cortical table had more significant predictors (thickness, tissue mineral density, and porosity) of mechanical response compared to the outer cortical table and diploë.

INTERPRETATION

Morphometric and geometric properties had a key influence on the calvarium's biomechanics. Trabecular bone pattern factor and the morphometry and geometry of the cortical tables must be considered when evaluating the mechanical response of the calvarium. These properties can aid the design of surrogate models of the skull that seek to mimic its mechanical response for head impact simulation.

The Mechanical Characterization and Comparions of Male and Female Calvaria Under Four-Point Bending Impacts

The circumstances in which we mechanically test and critically assess human calvarium tissue would find relevance under conditions encompassing real-world head impacts. These conditions include, among other variables, impact velocities, and strain rates. Compared to quasi-static loading on calvaria, there is less reporting on the impact loading of the calvaria and consequently, there are relatively fewer mechanical properties on calvaria at relevant impact loading rates available in the literature. The purpose of this work was to report on the mechanical response of 23 human calvarium specimens subjected to dynamic four-point bending impacts. Impacts were performed using a custom-built four-point impact apparatus at impact velocities of 0.86-0.89 m/s resulting in surface strain rates of 2-3/s-representative of strain rates observed in vehicle collisions and blunt impacts. The study revealed comparable effective bending moduli (11-15 GPa) to the limited work reported on the impact mechanics of calvaria in the literature, however, fracture bending stress (10-47 MPa) was relatively less. As expected, surface strains at fracture (0.21-0.25%) were less compared to studies that performed quasi-static bending. Moreover, the study revealed no significant differences in mechanical response between male and female calvaria. The findings presented in this work are relevant to many areas including validating surrogate skull fracture models in silico or laboratory during impact and optimizing protective devices used by civilians to reduce the risk of a serious head injury.

A methodology to evaluate different histological preparations of soft tissues: Intervertebral disc tissues study

A tissue preparation method will inevitably alter the tissue content. This study aims to evaluate how different common sample preparation methods will affect the tissue morphology, biomechanical properties, and chemical composition of samples. The study focuses on intervertebral disc (IVD) tissue; however, it can be applied to other soft tissues. Raman spectroscopy synchronized with nanoindentation instrumentation was employed to investigate the compositional changes of IVD, specifically, nucleus pulposus (NP) and annulus fibrosus (AF), together with their biomechanical properties of IVD. These properties were examined through the following histological specimen types: fresh cryosection (control), fixed cryosection, and paraffin-embedded. The IVD tissue could be located using an optical microscope under three different preparation methods. Paraffin-embedded samples showed the most explicit details where the lamellae structure of AF could be identified. In terms of biomechanical properties, there was no significant difference between the fresh and fixed cryosection (p > 0.05). In contrast, the fresh cryosection and paraffin-embedded samples showed a significant difference (p < 0.05). It was also found that the tissue preparations affected the chemical content of the tissues and structure of the tissue, which are expected to contribute to biomechanical properties changes. Fresh cryosection and fixed cryosection samples are more promising to work with for biomechanical assessment in histological tissues. The findings fill essential gaps in the literature by providing valuable insight into the characteristics of IVD at the microscale. This study can also become a reference for a better approach to assessing the mechanical properties and chemical content of soft tissues at the microscale.

DOES CEMENT CURING CAUSE CONCERNING INCREASE OF THE TEMPERATURE WHEN DELIVERED IN THE HUMAN HUMERUS?

For the treatment of humeral fractures, numerous strategies exist to improve the clinical outcome of the reconstruction and to reduce the incidence of fixation failure. Injection of acrylic-based cements to reinforce the bone and/or augment the screws is one option. The heat generated during cement polymerization raises some concerns, as it could cause tissue damage. The first aim of this study was to measure the temperature over time during polymerization when acrylic cements are delivered inside the bone to treat fracture. The second aim was to assess if the ISO-5833:2002 standard can predict what happens in a real bone. Different tests were performed using two acrylic-based cements (Mendec and Cal-Cemex): (i) the ISO-5833:2002 standard (Annex C); (ii) tests on human bones (humeral diaphysis and humeral head) injected with cement to simulate fracture treatment. In the humeri, the highest temperature was measured in the diaphysis (68.6∘C for Mendec, 62.7∘C for Cal-Cemex). These values are comparable with the temperature reached in other consolidated applications (vertebroplasty). Exposure to high temperature was shorter for the diaphysis than for the head. For both cements, in both the diaphysis and the head, temperatures exceeded 48∘C for less than 10[Formula: see text]min. This is within the threshold for tissue necrosis. The ISO-5833:2002 yielded significantly different results in terms of maximum temperature (difference exceeding 15∘C) and exposure to temperature above 48∘C and 45∘C. This discrepancy is probably due to a combination of factors affecting the amount of heat produced and dissipated (e.g., amount and shape of the cement, thermal conductivity).

Subchondral bone strength of the sacroiliac joint-a combined approach using computed tomography osteoabsorptiometry (CT-OAM) imaging and biomechanical validation

Bone mineral density distribution patterns at the sacroiliac joint (SIJ) may reflect long-term adaptation patterns to the loading the joint endures. This study aims to display bone mineralisation patterns of the articular SIJ subchondral lamella using computed tomography (CT) osteoabsorptiometry and mechanical indenting, to determine whether a relationship exists between mineralisation and mechanical strength. Twenty hemipelves were CT-scanned before osteoabsorptiometry densitograms were derived. Each articular side of eleven SIJs was mechanically indented following a 10-mm grid scheme. The sacral surface displayed lower Hounsfield unit (HU) values (≤ 700 HU) than the iliac side (> 700 HU). The apex, superior corner and borders yielded the highest HU scores (> 700 HU). Penetration strength was significantly higher on the iliac side (p < 0.04). Mineral density correlated positively with penetration strength of the subchondral bone layer (p < 0.05). No correlations were found between the HU values, nor between penetration strength of corresponding sides of the same SIJ in the majority of cases (p > 0.05). The iliac subchondral lamella is mechanically denser than the sacral aspect. The non-correlation between density and bone strength of articulating sides indicates biomechanical non-conformity. Loading throughout the SIJ may follow a complex distribution pattern involving the surrounding soft tissues, suspending the sacrum between the ilia.

Relationship between bullet diameter and bullet defect diameter in human calvariums

Existing literature on the relationship between bullet diameter and bullet defect diameter in the human calvarium is summarized and discussed. The hypothesis, derived from the literature, that bullet deformation influences bullet defect diameter was studied in a small controlled experiment. The mean defect size caused by non-deforming projectiles was found to be smaller than the mean defect size caused by deforming projectiles of equal original mass and size. The p value of the difference between the two means, measured in two different ways, was found to be 0.002 for both in a Mann–Whitney U test and was significant if the confidence level is set at 5%.

An Investigation on the Correlation between the Mechanical Properties of Human Skull Bone, Its Geometry, Microarchitectural Properties, and Water Content

With increasingly detailed imaging and mechanical analysis, modalities need arises to update methodology and assessment criteria for skull bone analysis to understand how bone microarchitecture and the presence of attached tissues may affect the response to mechanical load. The main aim was to analyze the effect of macroscopic and microstructural features, as well as periosteal attachment, on the mechanical properties of human skull bone. Fifty-six skull specimens from ethanol-phenoxyethanol-embalmed cadavers were prepared from two human cadavers. Assuming symmetry of the skull, all samples from one-half each were stripped of periosteum and dura mater, while the soft tissues were kept intact on the remaining samples on the contralateral side. The specimens were analyzed using microcomputed tomography to assess trabecular connectivity density, total surface area, and volume ratio. The specimens were loaded under three-point bend tests until fracture with optical co-registration. The bone fragments were then lyophilized to measure their water content. With increasingly detailed imaging and mechanical analysis modalities, there is a need to update methodology and assessment criteria for skull bone analysis to understand how the bone microarchitecture and the presence of attached tissues may affect the response to mechanical load. The mechanical properties were negatively correlated to bone thickness and water content. Conversely, most microarchitectural features did not influence either mechanical parameter. The correlation between mechanical response data and morphologic properties remains similar between the results of embalmed tissues presented here and fresh osseous tissue from literature data. The findings presented here add to the existing methodology to assess human skull for research purposes. The interaction between most microarchitectural features in ethanol-phenoxyethanol-embalmed embalmed skull samples and bending stress appear to be minute.

Mechanical properties of infant bone

Although an understanding of bone material properties is crucial for interpreting and predicting fracture patterns due to injury or defining the effects of disease on bone strength, information about infant bone properties is scant in the literature. In this study we present the mechanical testing results from 47 tibia and 52 rib specimens taken from 53 infant decedents in order to further our understanding of infant bone strength. Bone specimens were imaged using microCT and tested in three-point bending until failure. Extrinsic and intrinsic properties demonstrated an increase in strength and stiffness over the first year of life, while ductility measures remained largely unchanged. Donor race had no effect on the material properties, but tibia bone specimens showed significant sex differences, with the elastic modulus from females being larger than males. When compared to properties from adolescent and adult donors, infant bone is less strong, less stiff, and more ductile.

The effect of storage time in saline solution on the material properties of cortical bone tissue

BACKGROUND

The use of saline in preserving bone specimens may affect the mechanical properties of specimens. Yet, the reported effects varied and contradicted to each other, with a lack of investigating constitutive material parameters. Therefore, we quantified the effects of preservation time on the constitutive properties of cortical bone.

METHODS

We collected 120 specimens from the mid-diaphysis of six male bovine femora, which were assigned to five groups, including fresh-frozen for 60 days (-20 °C), storage in saline for 3, 10, 36 and 60 days (25 °C). All specimens underwent quasi-static three-point bending tests with a loading rate of 0.02 mm/s. Using the optimization method combined with specimen-specific finite element models, the Young's modulus, tangent modulus, yield stress, effective plastic strain, yield strain, ultimate stress, and toughness were calculated.

FINDINGS

Saline preservation resulted in a significant decrease of Young's modulus, yield stress, ultimate stress and pre-yield toughness (P < 0.001), and a significant increase of effective plastic strain (P = 0.034). After 10 days of preservation, yield stress and pre-yield toughness decreased -14.9% and -21.4%, respectively, and they continued to decrease with longer preservation time. After 36 days of preservation, Young's modulus and ultimate stress decreased -19.2% and -17.3%, respectively, and continued to decrease with longer preservation time. Our data also showed changes of material properties collected after 3-day saline preservation, while the low statistical power must be considered for this group.

INTERPRETATION

Saline preservation impacts on mechanical properties of cortical bone tissue and the effect is already observable after 3 days.

Improving results in rat fracture models: enhancing the efficacy of biomechanical testing by a modification of the experimental setup

Background

Animal fracture models, primarily performed in rats, are crucial to investigate normal and pathological bone healing. However, results of biomechanical testing representing a major outcome measure show high standard deviations often precluding statistical significance. Therefore, the aim of our study was a systematical examination of biomechanical characteristics of rat femurs during three-point bending. Furthermore, we tried to reduce variation of results by individually adapting the span of bearing and loading areas to the bone’s length.

Methods

We examined 40 paired femurs of male Wistar-rats by DXA (BMD and BMC of the whole femur) and pQCT-scans at the levels of bearing and loading areas of the subsequent biomechanical three-point bending test. Individual adjustment of bearing and loading bars was done respecting the length of each specimen. Subgroups of light (< 400 g, n = 22) and heavy (> 400 g, n = 18) animals were formed and analysed separately. We furthermore compared the results of the individualised bending-setting to 20 femurs tested with a fix span of 15 mm.

Results

Femurs showed a length range of 34 to 46 mm. The failure loads ranged from 116 to 251 N (mean 175.4 ± 45.2 N; heavy animals mean 221 ± 18.9 N; light animals mean 138.1 ± 16.4 N) and stiffness ranged from 185 N/mm to 426 N/mm (mean 315.6 ± 63 N/mm; heavy animals mean 358.1 ± 34.64 N/mm; light animals mean 280.8 ± 59.85 N/mm). The correlation of densitometric techniques and failure loads was high (DXA R² = 0.89 and pQCT R² = 0.88). In comparison to femurs tested with a fix span, individual adaptation of biomechanical testing homogenized our data significantly. Most notably, the standard deviation of failure loads (221 ± 18.95 N individualized setting vs. 205.5 ± 30.36 N fixed) and stiffness (358.1 ± 34.64 N/mm individualized setting vs. 498.5 ± 104.8 N/mm fixed) was reduced by at least one third.

Conclusions

Total variation observed in any trait reflects biological and methodological variation. Precision of the method hence affects the statistical power of the study. By simply adapting the setting of the biomechanical testing, interindividual variation could be reduced, which improves the precision of the method significantly.

Electronic supplementary material

The online version of this article (10.1186/s12891-018-2155-y) contains supplementary material, which is available to authorized users.

Acute exposure of white-tailed deer cortical bone to Staphylococcus aureus did not result in reduced bone stiffness

Staphylococcus aureus (S. aureus) is the main source of osteomyelitis in adults. The end-result of untreated osteomyelitis is bone necrosis and distraction of bone structure. While bone tissue can heal and remodel its structure to ameliorate its mechanical properties, so far no study has tested the mechanical properties of cortical bone tissue exposed to S. aureus. With the increase usage of bone banks as a source of bone graft supply, it is important to screen for any possible pathology that may affect the bone graft success to function normally in the receiving patient. This study tested the effect of acute exposure to S. aureus on cortical bone stiffness. We have postulated that the incubation of cortical bone with S. aureus for 48 h will result in a significant decrease in bone stiffness. Sixty-five bone cubes (2 × 2 × 2 mm) were prepared from the cranial and caudal aspects of four white-tailed deer mid-diaphysis humeri. First, all bone samples were tested to determine their stiffness in the three principle orientations (axial, radial and transverse). Next, bone samples were incubated for 48 h with S. aureus (32 cubes, experimental group) or with sterile distilled water (33 cubes, control group). Finally, all cubes were mechanically tested again and each stiffness value was compared to the original value obtained from the same cube. Our results revealed that overall, acute exposure to S. aureus did not significantly decrease bone stiffness and thus our working hypothesis could not be supported. Therefore, our findings support the current tissue collection screening methods employed by bone-graft banks.

Even with rehydration, preservation in ethanol influences the mechanical properties of bone and how bone responds to experimental manipulation

Typically, bones are harvested at the time of animal euthanasia and stored until mechanical testing. However, storage methods are not standardized, and differential effects on mechanical properties are possible between methods. The goal of this study was to investigate the effects that two common preservation methods (freezing wrapped in saline-soaked gauze and refrigerating ethanol fixed samples) have on bone mechanical properties in the context of an in vitro ribosylation treatment designed to modify mechanical integrity. It was hypothesized that there would be an interactive effect between ribose treatment and preservation method. Tibiae from twenty five 11week old female C57BL/6 mice were separated into 2 preservation groups. Micro-CT scans of contralateral pairs assessed differences in geometry prior to storage. After 7weeks of storage, bones in each pair of tibiae were soaked in a solution containing either 0M or 0.6M ribose for 1week prior to 4 point bending tests. There were no differences in any cortical geometric parameters between contralateral tibiae. There was a significant main effect of ethanol fixation on displacement to yield (-16.3%), stiffness (+24.5%), strain to yield (-13.9%), and elastic modulus (+18.5%) relative to frozen specimens. There was a significant main effect of ribose treatment for yield force (+13.9%), ultimate force (+9.2%), work to yield (+22.2%), yield stress (+14.1%), and resilience (+21.9%) relative to control-soaked bones. Postyield displacement, total displacement, postyield work, total work, total strain, and toughness were analyzed separately within each preservation method due to significant interactions. For samples stored frozen, all six properties were lower in the ribose-soaked group (49%-68%) while no significant effects of ribose were observed in ethanol fixed bones. Storage in ethanol likely caused changes to the collagen matrix which prevented or masked the embrittling effects of ribosylation that were seen in samples stored frozen wrapped in saline-soaked gauze. These data illustrate the clear importance of maintaining hydration if the eventual goal is to use bones for mechanical assessments and further show that storage in ethanol can alter potential to detect effects of experimental manipulation (in this case ribosylation).

High fat-fed diabetic mice present with profound alterations of the osteocyte network

Diabetes mellitus is considered to be an independent risk factor for bone fragility fractures. Reductions in bone mass, observed only with type 1 diabetes mellitus, as well as modifications of bone microarchitectures and tissue material properties are landmarks of diabetes-related bone alterations. An interesting feature observed in type 2 diabetes mellitus (T2DM) is the augmented concentration in circulating sclerostin. This observation prompts us to hypothesize that modifications of osteocyte network and perilacunar mineralization occur in T2DM. As such, the aims of the present study were to ascertain by quantitative backscattered electron imaging, confocal microscopy and image analysis, modifications of perilacunar tissue mineral density, osteocyte morphology and osteocyte network topology in a mouse model of high fat-induced type 2 diabetes. As compared with lean control animals, diabetic mice exhibited a significant 48% decrease in perilacunar mineralization heterogeneity although mean perilacunar mineralization was unchanged. Furthermore, in diabetic animals, osteocyte volume was significantly augmented by 34% with no change in the overall number of dendrite processes. Finally, the network topology was profoundly modified in diabetic mice with increases in the mean node degree, mean node volume and hub numbers whilst the mean link length was reduced. Overall, it appeared that in diabetic animals, the dendritic network exhibited features of a scale-free network as opposed to the single-scale characteristic observed in lean controls. However, it is important to ascertain whether diabetic patients exhibit such modifications of the osteocyte network and whether anti-diabetic drugs could restore normal osteocyte and network parameters, thereby improving bone quality and protecting against fragility fractures.