Microindentation: A New Technique for Bone Quality Assessment

Fractures are the result of the application of a greater force on bone than its strength. Therefore, to understand fracture physiopathology, it is essential to know bone strength determinants. These include bone mineral density (BMD), bone spatial structure (bone geometry and microarchitecture) and bone mechanical and tissue properties. While BMD and bone spatial structure can be easily evaluated through imaging technology, assessment of bone tissue and mechanical properties is complex and typically requires invasive techniques that are not suitable in clinical practice. Microindentation is a relatively recently developed technique that directly measures bone tissue and mechanical properties in patients in a fast, safe, feasible and minimally invasive way. It appears to be particularly informative in diseases associated with an increased risk of fracture not explained by BMD values as occurs in X-linked hypophosphataemia (XLH). The aim of this article is to provide an overview on bone microindentation and its potential utility in the evaluation of patients with XLH.