In Vivo Assessment of Cortical Bone Fragility

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. Summary Because CBMT is a whole bone test, its measurements reflect the influences of bone quantity and bone quality at all hierarchical levels.

Fracture discrimination capability of ulnar flexural rigidity measured via Cortical Bone Mechanics Technology: study protocol for The STRONGER Study

“…This is supported by high false negative rates of 83% and 95% for women and men, respectively. 13 Similarly, there is evidence indicating that the rate of BMD loss does not predict fragility fracture, largely due to significant measurement errors resulted in the unreliable estimates. 22 …”

“…Bone strength can be quickly and painlessly assayed non-invasively, without the use of radiation, using a 3-point bend test performed with multifrequency vibration analysis to measure the resonance response of the bone (for reviews, see 13 , 31 ). More than 25 yr ago, initial efforts were made to develop and commercialize a vibration analysis device for bone strength assessment, known as mechanical response tissue analysis or MRTA.…”

“… 40 Cortical Bone Mechanics Technology incorporates several noteworthy improvements, such as the integration of robotics and machine intelligence to (1) collect data at multiple sites across the mid-shaft of the ulna bone in the forearm, overcoming issues around probe placement and (2) employ novel algorithms to real-time recognition of distinctive features in accurate data. 13 , 40 Furthermore, the hardware design of CBMT has been refined to provide adjustable and stable end conditions, ensuring a more idealized 3-point bend test (refer to the "Methods” section for additional details).…”

“…Cortical Bone Mechanics Technology utilizes multifrequency vibration analysis to conduct a noninvasive, dynamic 3-point bending test, enabling direct and functional mechanical measurements of ulnar cortical bone, such as flexural rigidity. 13 , 40 As a whole bone test, CBMT’s measurements reflect the combined influences of bone quantity, structure, and quality at all hierarchical levels. 13 , 40 Its validity in accurately measuring ulna flexural rigidity and estimating quasistatic ulna bending strength has been demonstrated.…”

The progress in quantitative evaluation of callus during distraction osteogenesis

“…The hardness of the bone can be calculated according to the geometric calculation of the diamond probe [ 76 , 77 ]. Researchers are trying to develop a noninvasive biomechanical detection method for its clinical application [ 78 , 79 ]. Recently, in vivo monitoring technology has emerged, mainly focusing on the changes in mechanical parameters with time during the mineralization of new tissues [ 80 – 83 ].…”