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Review
. 2020 Feb;18(1):13-22.
doi: 10.1007/s11914-020-00558-7.

In Vivo Assessment of Cortical Bone Fragility

Lyn Bowman  1   2 , Anne B Loucks  3
Affiliations
Review

In Vivo Assessment of Cortical Bone Fragility

Lyn Bowman et al. Curr Osteoporos Rep. 2020 Feb.

Abstract

Purpose of review: This review updates readers on recent developments in the assessment of cortical bone fragility in vivo. The review explains the clinical need that motivated the development of Cortical Bone Mechanics Technology™ (CBMT) as a scientific instrument, its unique capabilities, and its necessary further development as a medical device.

Recent findings: Clinical experience with dual-energy X-ray absorptiometry has led to calls for new clinical methods for assessing bone health. CBMT is a noninvasive, dynamic 3-point bending test that makes direct, functional measurements of the mechanical properties of cortical bone in ulnas of living people. Its technical validity in accurate measurements of ulna flexural rigidity and its clinical validity in accurate estimations of quasistatic ulna bending strength have been demonstrated. Because CBMT is a whole bone test, its measurements reflect the influences of bone quantity and bone quality at all hierarchical levels.

Keywords: Bending test; Bone mechanics; Bone stiffness; Bone strength; Cortical bone; Fracture.

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Conflict of interest statement

Lyn Bowman is an investor on related US (10,299,719) and European (2,983,592) patents assigned to Ohio University and Licensed to AEIOU Scientific, LLC. Lyn Bowman and Anne Loucks are unit holders in AEIOU Scientific, LLC.

Figures

Fig. 1
Fig. 1
The confusion matrix for using aBMD T-scores for allocating patients to treatment to prevent fractures. TP = True Positive, FP = False Positive, FN = False Negative, TN = True Negative
Fig. 2
Fig. 2
The confusion matrix for allocations of 1000 women (a) and 1000 men (b) to treatment based on T-scores of aBMD. FX = fracture, NFX = no fracture, FX T < −2.5 = fracture expected, NFX T > −2.5 = fracture not expected. (Data from [•])
Fig. 3
Fig. 3
Errors in the treatment of patients below a threshold value (XTreat) of a bone strength (Y) predictor X. (TP = True Positive, FP = False Positive, FN = False Negative, TN = True Negative)
Fig. 4
Fig. 4
Observed distributions of women with and without fractures allocated to treatment by the threshold TaBMD = −2.5. (FX = women with fractures, NFX = women without fractures, TP = True Positive, FP = False Positive, FN = False Negative, TN = True Negative, dT = increment of T-score)
Fig. 5
Fig. 5
Hypothetical distributions of strength in women with and without fractures exposed to a skewed distribution of forces. (All: white solid line = all women; NFX: black solid line = women with fractures, FX: black broken line = women without fractures; Forces: blue solid line; treatment threshold: yellow solid line at TStrength = −2.5; TP = True Positive, FP = False Positive, FN = False Negative, TN = True Negative)
Fig. 6
Fig. 6
Wide angle (a) and close-up (b) views of a CBMT test in progress. The ulna is tested because, of all the bones in the body, the biomechanics of the ulna are the most ideal for a bending test in vivo.
Fig. 7
Fig. 7
CBMT technical validity (a): ulna flexural rigidity (EI) calculated from CBMT and quasistatic (QMT) measurements of ulna bending stiffness. CBMT clinical validity (b): ulna bending strength (peak moment) measured by QMT in excised ulnas in relation to ulna EI calculated from CBMT and QMT measurements of ulna bending stiffness. ( [•], used with permission from Elsevier)
Fig. 8
Fig. 8
Stress-strain curves for bovine bone specimens loaded at various constant strain rates (from [35] redrawn with permission from [36]). Used with permission from Springer Nature
See this image and copyright information in PMC

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