Bone Quality Assessment Techniques: Geometric, Compositional, and Mechanical Characterization from Macroscale to Nanoscale

Abstract

This review presents an overview of the characterization techniques available to experimentally evaluate bone quality, defined as the geometric and material factors that contribute to fracture resistance independently of areal bone mineral density (aBMD) assessed by dual energy x-ray absorptiometry. The methods available for characterization of the geometric, compositional, and mechanical properties of bone across multiple length scales are summarized, along with their outcomes and their advantages and disadvantages. Examples of how each technique is used are discussed, as well as practical concerns such as sample preparation and whether or not each testing method is destructive. Techniques that can be used in vivo and those that have been recently improved or developed are emphasized, including high resolution peripheral quantitative computed tomography to evaluate geometric properties and reference point indentation to evaluate material properties. Because no single method can completely characterize bone quality, we provide a framework for how multiple characterization methods can be used together to generate a more comprehensive analysis of bone quality to complement aBMD in fracture risk assessment.

Bone quality changes associated with aging and disease: a review

“…These measures, in addition to BMD, explain bone strength. Numerous techniques exist to measure these quality variables, reviewed elsewhere, along with a few newer techniques referenced later. Architecture and geometry can be measured by micro‐, nano‐, or peripheral‐computerized tomography and by nuclear magnetic resonance imaging .…”

“…Damage has been assessed by basic Fuschin staining and more recently by synchrotron radiation transmission X‐ray microscopy with an X‐ray negative stain . Compositional measurements include classic methods and newer techniques reviewed elsewhere . NMR was similarly used to measure water content.…”

“…16 Compositional measurements include classic methods and newer techniques reviewed elsewhere. 4 NMR was similarly used to measure water content. Backscattered electron imaging and BMD distribution (BMDD) measurements along with vibrational spectroscopic imaging methods provide insight into spatially resolved compositional properties.…”

Altered Tissue Composition, Microarchitecture, and Mechanical Performance in Cancellous Bone From Men With Type 2 Diabetes Mellitus

“…(1,2) Furthermore, epidemiological studies that account for hip BMD, age, BMI, fracture history, neuropathy, retinopathy, and falls consistently underpredict fractures in men and women with T2DM. (1,3,4) Because these factors do not fully account for the increased fracture risk observed in patients with T2DM, additional factors, including bone quality, (5) may also contribute to the pathophysiology of T2DM-related fractures. Aspects of bone quality that may contribute to decreased fracture resistance in T2DM include bone microarchitecture and tissue material properties, 1191 ◼…”

The Microbial Metagenome and Tissue Composition in Mice with Microbiome-Induced Reductions in Bone Strength

“…To our knowledge, metagenomic analysis of the microbiome has not yet been used to understand the effects of the microbiome on bone. Additionally, although multiple studies report modifications in bone composition and nanomechanical properties in the context of bone quality and fracture risk (20,21,23-25) , no previous studies have evaluated changes in bone tissue composition associated with changes in the gut microbiome.…”