Mechanical competence of bone: a new parameter to grade trabecular bone fragility from tortuosity and elasticity

With the elderly population increase, osteoporosis and its consequences have become not just a health issue but also a serious economic burden. The trabecular bone structure plays a very important role for the bone quality and mechanical competence of the scaffold. Currently, it is claimed that the trabecular microarchitecture understanding can improve the fracture risk prediction above 65%. Several parameters seem to be correlated providing structural details of the trabecular bone network. However, the tortuosity of the trabeculae has not yet been systematically taken into account and its contribution has not been fully investigated and understood. In this paper, we discuss the relationship between the trabecular tortuosity, connectivity, volume fraction, and elasticity, and provide a unified parameter to estimate the mechanical competence of the structure. It is shown that the trabecular network tortuosity presents high linear correlation with the other parameters and that the trabeculae tend to get aligned in the direction where the structure is mostly submitted to stress, corresponding to higher stiffness orientation. This new parameter will help to integrate the relevant information of bone microarchitecture quality and assess more directly the real trabecular fragility in osteoporotic patients.