Nonlinear ultrasound can detect accumulated damage in human bone

Bone micro-damage is commonly accepted as a relevant parameter for fracture risk assessment, but there is no available technique for its non-invasive characterization. The objective of this work is to study the potential of nonlinear ultrasound for damage detection in human bone. Ultrasound is particularly desirable due to its non-invasive and non-ionizing characteristics. We show results illustrating the correlation of progressive fatigue of human bone samples to their nonlinear dynamical response. In our experiments, damage was induced in 30 samples of diaphyseal human femur using fatigue cycling. At intervals in the cycling, the nonlinear response of the samples was assessed applying Nonlinear Resonant Ultrasound Spectroscopy (NRUS). The nonlinear parameter alpha, which in other materials correlates with the quantity of damage, dramatically increased with the number of mechanical testing cycles. We find a large spread in alpha in the pristine samples and infer that the spread is due to damage differences in the sample population. As damage accumulates during cycling, we find that alpha is much more sensitive to damage than other quantities measured, including the slope and hysteresis of the load/displacement curve, and the dynamic wavespeed. To our knowledge, this study represents the first application of the concept of nonlinear dynamic elasticity to human bone. The results are promising, suggesting the value of further work on this topic. Ultimately, the approach may have merit for in vivo bone damage characterization.