Barbara R. McCreadie

Biomechanics of fracture: is bone mineral density sufficient to assess risk?

THIS ISSUEof the Journal includes an article by Beck et al. entitled “Structural Trends in the Aging Femoral Neck and Proximal Shaft: Analysis of the NHANES III DCS Data.” The authors show a change in the geometry of femurs with age, which appears to maintain the mechanical integrity of the femoral neck. Furthermore, the authors suggest that a loss in bone mass in the proximal femur may not be indicative of an increase in fracture risk, because of this geometric compensatory factor. These results, as well as others in the literature, encourage us to “step back” and review what we understand about fractures of the aging skeleton and what factors seem to be associated most with an increase in fracture risk. Popular conventional wisdom suggests that the most dominant factor related to skeletal fragility due to aging or osteoporosis is reduced bone mass. However, on further questioning, many experts would caution that measures of bone mass or density alone cannot reliably predict fracture risk in patients. Given this controversy and the fact that hundreds of studies have been conducted to examine the factors associated with osteoporotic fractures, it seems appropriate to revisit current perspectives. The following statements were excerpted directly from the literature and illustrate the continuing disagreements about fracture risk factors.

Osteocyte lacuna size and shape in women with and without osteoporotic fracture

Osteocytes have been hypothesized to control the amount and location of bone tissue which is resorbed or formed, based on the strain magnitude they perceive, and therefore may play a role in the bone loss of osteoporosis. The shape of osteocyte lacunae influences the mechanical strain applied to the osteocyte; thus, it is important to quantify their shape to further understand the mechanical environment of this cell. Previous studies of the size and shape of lacunae have been contradictory and limited to two-dimensional measurements on iliac crest biopsies. This investigation measured the size and shape of osteocyte lacunae in trabecular bone near a typical fracture site from three-dimensional image sets obtained by confocal microscopy. Bone tissue specimens were obtained from individuals undergoing hip replacement subsequent to fracture, and matched cadaveric specimens without fracture. After extensive image processing to differentiate the lacunae from the matrix, the volume and anisotropy of the lacuna were determined. No significant difference was found in the size (volume) or shape (anisotropy) of the lacunae between women with and without osteoporotic fracture, although there was a large range of sizes and shapes in both groups. These results suggest that the size or shape of the lacunae, which influences the strain in osteocytes, does not play a role in osteoporotic fracture. In addition, this study provides geometric measures of lacunae that are important in computational modeling of the mechanical environment of osteocytes.

The dependence of the elastic properties of osteoporotic cancellous bone on volume fraction and fabric.

Osteoporosis is a progressive systemic skeletal condition characterized by low bone mass and microarchitectural deterioration, with a consequent increase in susceptibility to fracture. Hence, osteoporosis would be best diagnosed by in vivo measurements of bone strength. As this is not clinically feasible, our goal is to estimate bone strength through the assessment of elastic properties, which are highly correlated to strength. Previously established relations between morphological parameters (volume fraction and fabric) and elastic constants could be applied to estimate cancellous bone stiffness in vivo. However, these relations were determined for normal cancellous bone. Cancellous bone from osteoporotic patients may require different relations. In this study we set out to answer two questions. First, can the elastic properties of osteoporotic cancellous bone be estimated from morphological parameters? Second, do the relations between morphological parameters and elastic constants, determined for normal bone, apply to osteoporotic bone as well? To answer these questions we used cancellous bone cubes from femoral heads of patients with (n=26) and without (n=32) hip fractures. The elastic properties of the cubes were determined using micro-finite element analysis, assuming equal tissue moduli for all specimens. The morphological parameters were determined using microcomputed tomography. Our results showed that, for equal tissue properties, the elastic properties of cancellous bone from fracture patients could indeed be estimated from morphological parameters. The morphology-based relations used to estimate the elastic properties of cancellous bone are not different for women with or without fractures.

Band-Target Entropy Minimization (BTEM) Applied to Hyperspectral Raman Image Data:

Band-target entropy minimization (BTEM) has been applied to extraction of component spectra from hyperspectral Raman images. In this method singular value decomposition is used to calculate the eigenvectors of the spectroscopic image data set. Bands in non-noise eigenvectors that would normally be used for recovery of spectra are examined for localized spectral features. For a targeted (identified) band, information entropy minimization or a closely related algorithm is used to recover the spectrum containing this feature from the non-noise eigenvectors, plus the next 5–30 eigenvectors, in which noise predominates. Tests for which eigenvectors to include are described. The method is demonstrated on one synthesized Raman image data set and two bone tissue specimens. By inclusion of small amounts of signal that would be unused in other methods, BTEM enables the extraction of a larger number of component spectra than are otherwise obtainable. An improvement in signal/noise ratio of the recovered spectra is also obtained.

Strain Concentrations Surrounding an Ellipsoid Model of Lacunae and Osteocytes

Direct cell sensing of tissue matrix strains is one possible signaling mechanism for mechanically mediated bone adaptation. We utilized homogenization theory to estimate bone tissue matrix strains surrounding osteocytes using two sets of models. The first set of models estimated the strain levels surrounding the lacunae and canaliculi, taking into account variations in lamellar properties. The second set estimated strain levels in the osteocyte and the surrounding matrix for different cellular mechanical properties. The results showed that the strain levels found in and surrounding osteocytes, 1700 to 2700 microstrain (denoted as µe; 1 µe =.0001% strain), were significantly greater than the trabecular tissue level strains of {1325 µe, 287 µe, 87 µe} used for model input. Variation in lamellar properties did not affect strain levels, except at lamellar boundaries. Strain in and surrounding the osteocyte was not significantly affected by cellular stiffness ranging between 28 and 28, 000 Pascals (Pa). Strain levels surrounding lacunae and canaliculi were approximately equivalent.

Hierarchical Structure of Bone and Micro-Computed Tomography

Bone is highly complex, with multiple hierarchical levels of structure. Micro-CT has been able to provide much information about the properties of bone at several of these levels at the mid-range of bones hierarchical structure, and it will continue to provide a valuable tool for further characterizing bone in various conditions and explaining mechanisms of bone failure.