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Updated: Jun 27, 2026
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Assessment of Bone Fracture Healing Using Micro-Computed Tomography
Published on: December 9, 2022
Beyond SINS: A Critical Review of Biomechanical, Microstructural, and Radiomic Biomarkers for Predicting Fracture
An Sen Tan1, Calvin Kai En Tjio1, Jonathan Jiong Hao Tan2
1Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore.
Diagnostics (Basel, Switzerland)
|June 26, 2026
Summary
New markers like biomechanical modeling and radiomics may improve spinal fracture risk assessment in cancer patients, moving beyond the current Spinal Instability Neoplastic Score (SINS). Further validation is needed for clinical use.
Area of Science:
- Oncology
- Radiology
- Biomechanics
Background:
- The Spinal Instability Neoplastic Score (SINS) has limitations in accurately assessing spinal metastases fracture risk due to heterogeneous patient outcomes and implementation challenges.
- Current SINS criteria show variable correlation with fracture risk and suffer from interobserver variability and time burdens.
- SINS lacks sensitivity in detecting early structural compromise in treatment-naive patients and those affected by radiation therapy.
Purpose of the Study:
- To review emerging imaging, biomechanical, and microstructural markers for enhanced fracture risk stratification in spinal oncology.
- To address the limitations of traditional SINS criteria in assessing spinal stability and predicting fracture risk.
- To propose a new framework for multiparametric assessment of spinal stability in cancer patients.
Main Methods:
- Synthesized evidence on biomechanical modeling, including CT-based finite element analysis and failure-load models.
- Evaluated radiomics features from radiological imaging for predictive model development.
- Explored microstructural MRI biomarkers (Vertebral Bone Quality, fat fraction, muscle atrophy) for metastatic spine applications.
Main Results:
- Emerging biomechanical, radiomic, and microstructural markers show promise in overcoming SINS limitations for fracture risk stratification.
- These novel markers offer potential for more precise risk assessment across the spinal oncology treatment continuum.
- Current evidence is primarily retrospective, necessitating further validation for clinical adoption.
Conclusions:
- A paradigm shift from conventional SINS scoring to multiparametric assessment is proposed for spinal stability.
- Emerging markers have the potential to improve prognostication and guide treatment decisions in spinal oncology.
- Further research and validation are crucial for integrating these advanced techniques into clinical practice.
