Stiffness and strength of bone in osteoporotic patients treated with varying durations of oral bisphosphonates

Ward, Jonathan Joseph; Wood, Constance L.; Rouch, Keith E.; Pienkowski, David; Malluche, H H

doi:10.1007/s00198-016-3661-0

Cited by 22 publications

(27 citation statements)

References 53 publications

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“…Ward et al [2] have applied this technique in such a case. Long-term treatments with bisphosphonates (BPs) have been suspected of causing bone material to become more brittle, leading to atypical femoral fractures (AFF).…”

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confidence: 99%

“…This seems self-evident. Ward et al [2] state that different mesh densities were explored, and these are apparently published in several Master's theses, although it is not clear if they are easily available.…”

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confidence: 99%

“…One can imagine that the stresses generated within a bone that is fixed (as when the foot is planted on the ground) will be different than those generated when the end of the limb, or bone, is free move (reducing the stresses). Ward et al [2] have defined these boundary conditions, specifying that the bottom finite element nodes are constrained; whereas the top 5 % of the nodes are subject to 1 % axial compressive strain. However, boundary conditions also will determine how the structure will behave along nonsmooth boundaries, many of which exist in trabecular bone.…”

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confidence: 99%

“…Validity and sensitivity depend on which parameters were chosen to describe the properties of the structure, the mesh density, boundary conditions, and conditions of bone's linear elasticity, homogeneity and anisotropy. Ward et al [2] used an isotropic, homogeneous, and linearly elastic model. A parametric analysis of conditions used in the model would therefore have yielded only proportional differences in apparent modulus and stress.…”

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confidence: 99%

“…Nor is there evidence of architectural deterioration from prolonged BP treatment in human clinical trials. So, while the results of Ward et al [2] remain intriguing, particularly in light of what we now know are negative effects of prolonged treatment with BPs on bone, the reason for the effect remains controversial. In that sense, the Ward [2] article is important in pointing out areas in which further experimental work needs to be done, a vital role of the hypothesisformation function that FEA should serve.…”

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confidence: 99%

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The use of finite element analysis to estimate the changing strength of bone following treatment for osteoporosis

Burr

2016

Osteoporos Int

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Finite element analysis (FEA) is a computational technique widely used to estimate the behavior of structures under loading. It is particularly valuable to investigate those conditions which cannot be studied directly by experimentation, and therefore, provides valuable information that cannot be obtained in more direct ways. It has been beneficial in helping to create and optimize non-biological structures for instance, how to engineer an airplane wing to prevent failure from excessive fatigue loading but can also help us to understand how a structure might behave mechanically under various conditions that cannot be reproduced experimentally. Briefly, the technique uses a series of small elements that can be a variety of shapes, and that are connected at nodal points, to computergenerate a morphological structure, such as a hip joint. The elements can be assigned properties that are indicative of the tissue properties that small areas of the biological structure have, either relying on measurements that have been made of the properties of the material, or in those cases in which the properties have not been measured, estimating them based on what we do know. For most models, properties for elastic modulus (tissue stiffness) are assigned to the entire structure, which can be a poor representation of bone tissue properties given one's heterogeneity, rather than to individual elements, A virtual load can be applied to this structure, and the displacement (or deformation) of the structure under that loading condition can be estimated. A second method, known as the flexibility method, is based on known displacements. Knowing the load and the displacement, it is possible to calculate the stresses and strains within the structure, which can provide valuable information to estimate how the structure will Bperform^mechanically. Stresses and strains are Bderived^parameters that require calculation from the estimated displacements, so are less accurate (or more variable) than the estimated displacements [1]. Nevertheless, the FEA can provide an estimate of the stresses and strains within a structure that cannot be determined in other ways because they cannot be directly measured. If it were possible to do an experiment in which the effect could be directly measured, then

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The use of finite element analysis to estimate the changing strength of bone following treatment for osteoporosis

Burr

2016

Osteoporos Int

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Bone Quality and Fractures in Women With Osteoporosis Treated With Bisphosphonates for 1 to 14 Years

et al. 2021

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Trabecular bone microcrack accumulation in patients treated with bisphosphonates for durations up to 16 years

Pienkowski

Wood

Malluche

2022

Journal Orthopaedic Research

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This study quantified the length, number, and density of microcracks in bone from patients treated with bisphosphonates as a function of duration. Anterior iliac crest bone samples from 51 osteoporotic Caucasian females continuously treated with oral bisphosphonates for 1-16 years were obtained by bone biopsy. Samples were histologically processed and analyzed for bone area, microcrack number, and microcrack length. The analyses used statistical modeling and considered patient age, bone mineral density, bone volume/total volume, trabecular thickness, and bone turnover as potential covariates. Microcrack density (number of microcracks/total examined bone area) was linearly related (p = 0.018) to bisphosphonate treatment duration. None of the analyzed covariates contributed significantly to the observed relationship between microcrack density and bisphosphonate treatment duration. Observed increases in microcrack density with increasing bisphosphonate treatment duration is important because increasing levels of microcracks may not only affect bone remodeling but also reduce elastic modulus and are suspected to adversely affect other mechanical properties that may influence fracture risk. The present findings add to our prior results showing changes in bone material properties and modulus with bisphosphonate treatment duration and thereby provide a more comprehensive assessment of the relationship between bisphosphonate treatment duration and bone quality. Statement of Clinical Significance: The present findings provide information guiding clinical use of oral bisphosphonates for post-menopausal osteoporosis therapy.

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Stiffness and strength of bone in osteoporotic patients treated with varying durations of oral bisphosphonates

Cited by 22 publications

References 53 publications

The use of finite element analysis to estimate the changing strength of bone following treatment for osteoporosis

The use of finite element analysis to estimate the changing strength of bone following treatment for osteoporosis

Bone Quality and Fractures in Women With Osteoporosis Treated With Bisphosphonates for 1 to 14 Years

Trabecular bone microcrack accumulation in patients treated with bisphosphonates for durations up to 16 years

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