A clinically applicable energy-based approach for evaluating bone strength.

Area of Science:

• Biomedical Engineering
• Orthopedics
• Skeletal Biology

Background:

• Bone mineral density (BMD) is the current standard for diagnosing osteoporosis but doesn't fully capture bone strength.
• Assessing bone yield strength is crucial for biomechanical competence but typically requires destructive testing.
• Developing non-destructive methods for bone yield strength assessment is essential for accurate osteoporosis diagnosis and management.

Purpose of the Study:

• To develop and validate clinically feasible models for predicting bone yield strength.
• To improve osteoporosis identification by moving beyond bone mineral density measurements.
• To establish both intraoperative and preoperative approaches for assessing bone biomechanical competence.

Main Methods:

• Developed an intraoperative model using surgical mechanical data (axial force, torque) and finite element analysis (FEA).
• Created a preoperative model utilizing demographic and noninvasive measures.
• Calibrated models using synthetic bone analogues (SBA) and ex vivo human cancellous bone, validating against uniaxial compression tests.

Main Results:

• The intraoperative model accurately predicted vertebral yield strength.
• The preoperative model demonstrated high performance (R² = 0.99) using variables like T-score, Hounsfield units (HU), BMI, sex, and age.
• Both models successfully circumvented the need for destructive testing, showing high correlation and agreement with experimental data.

Conclusions:

• Two clinically applicable models for predicting bone yield strength have been successfully developed.
• The preoperative model offers a noninvasive method for patient risk stratification.
• The intraoperative model provides precise assessment of vertebral bone strength, enhancing osteoporosis diagnosis.