Variability in reference point microindentation and recommendations for testing cortical bone: Location, thickness and orientation heterogeneity

Coutts, Louise V.; Jenkins, T.; Li, T.; Dunlop, D.G.; Oreffo, R.O.C.; Cooper, Cyrus; Harvey, Nicholas C; Thurner, Philipp J.; Arden, N K; Latham, Jeremy M.; Taylor, P; Baxter, Mark; Moss, N.; Ball, Christopher; Chan, Kwai S.

doi:10.1016/j.jmbbm.2015.02.004

Cited by 18 publications

(23 citation statements)

References 26 publications

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“…It also does not allow a proper investigation of the role of RPI alongside FRAX, which is designed to identify those individuals who would benefit from treatment for osteoporosis, rather than to identify individuals who have fractured. Second, although the results do confirm clinical differences measured at the tibia, and there is a known relationship between peripheral measures and hip fracture risk, we have also shown that RPI varies along the femur . Furthermore, the femoral neck measurements appeared to be site specific, and discrimination was less robust for those in the inferomedial region as discussed by Coutts and colleagues in terms of density .…”

Section: Discussionsupporting

confidence: 72%

“…Furthermore, the femoral neck measurements appeared to be site specific, and discrimination was less robust for those in the inferomedial region as discussed by Coutts and colleagues in terms of density . This is perhaps because of RPI properties, similar to porosity and thickness, being protected through stance loading, whereas fractures initiate superolaterally in a fall . This site dependence, as well as use of the preclinical (Biodent) device, makes it unclear how the clinically determined tibial measurements (using the Osteoprobe) relate to the clinically inaccessible femoral neck and necessitates this comparison to be made to further develop RPI.…”

Section: Discussionmentioning

confidence: 99%

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Site-Dependent Reference Point Microindentation Complements Clinical Measures for Improved Fracture Risk Assessment at the Human Femoral Neck

Jenkins

Coutts

D’Angelo

et al. 2015

Journal of Bone and Mineral Research

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In contrast to traditional approaches to fracture risk assessment using clinical risk factors and bone mineral density (BMD), a new technique, reference point microindentation (RPI), permits direct assessment of bone quality; in vivo tibial RPI measurements appear to discriminate patients with a fragility fracture from controls. However, it is unclear how this relates to the site of the most clinically devastating fracture, the femoral neck, and whether RPI provides information complementary to that from existing assessments. Femoral neck samples were collected at surgery after low-trauma hip fracture (n ¼ 46; 17 male; aged 83 [interquartile range 77-87] years) and compared, using RPI (Biodent Hfc), with 16 cadaveric control samples, free from bone disease (7 male; aged 65 years). A subset of fracture patients returned for dual-energy X-ray absorptiometry (DXA) assessment (Hologic Discovery) and, for the controls, a micro-computed tomography setup (HMX, Nikon) was used to replicate DXA scans. The indentation depth was greater in femoral neck samples from osteoporotic fracture patients than controls (p < 0.001), which persisted with adjustment for age, sex, body mass index (BMI), and height (p < 0.001) but was site-dependent, being less pronounced in the inferomedial region. RPI demonstrated good discrimination between fracture and controls using receiver-operating characteristic (ROC) analyses (area under the curve [AUC] ¼ 0.79 to 0.89), and a model combining RPI to clinical risk factors or BMD performed better than the individual components (AUC ¼ 0.88 to 0.99). In conclusion, RPI at the femoral neck discriminated fracture cases from controls independent of BMD and traditional risk factors but dependent on location. The clinical RPI device may, therefore, supplement risk assessment and requires testing in prospective cohorts and comparison between the clinically accessible tibia and the femoral neck.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Site-Dependent Reference Point Microindentation Complements Clinical Measures for Improved Fracture Risk Assessment at the Human Femoral Neck

Jenkins

Coutts

D’Angelo

et al. 2015

Journal of Bone and Mineral Research

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“…A stabilizing reference force is applied to the reference probe to prevent the probe from lifting off the surface and then the test is run. There are a series of experiments reporting good practices for ex vivo testing that provide useful data for determining some of the test settings and showing how they affect the generated properties . It is also important to recognize when doing ex vivo testing that BioDent properties are sensitive to tissue anisotropy, so it is important to control and report the orientation of the specimen .…”

Section: Biodent and Osteoprobe: Related Devices With Distinct And Immentioning

confidence: 99%

“…There are a series of experiments reporting good practices for ex vivo testing that provide useful data for determining some of the test settings and showing how they affect the generated properties. (17,23) It is also important to recognize when doing ex vivo testing that BioDent properties are sensitive to tissue anisotropy, so it is showing apparent interaction between the reference probe damage and the test region damage. The authors' interpretation, based on this qualitative observation, is that the reference probe and test probe damage can interact.…”

Section: Biodent and Osteoprobe: Related Devices With Distinct And Immentioning

confidence: 99%

True Gold or Pyrite: A Review of Reference Point Indentation for Assessing Bone Mechanical Properties In Vivo

Allen

McNerny

Organ

et al. 2015

Journal of Bone and Mineral Research

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Although the gold standard for determining bones’ mechanical integrity is the direct measure of mechanical properties, clinical evaluation has long relied on surrogates of mechanical properties for assessment of fracture risk. Nearly a decade ago, reference point indentation (RPI) emerged as an innovative way to potentially assess mechanical properties of bone in vivo. Beginning with the BioDent device, and then followed by the newer generation OsteoProbe, this RPI technology has emerged in several papers. In this review we overview the technology and some important details about the two devices. We also highlight select key studies, focused specifically on the in vivo application of these devices, as a way of synthesizing where the technology stands in 2015. The BioDent machine has been shown, in two clinical reports, to be able to differentiate fracture versus non-fracture patient populations and in preclinical studies to detect treatment effects that are consistent with those quantified using traditional mechanical tests. The OsteoProbe appears able to separate clinical cohorts yet there exists a lack of clarity regarding details of testing, which suggests more rigorous work needs to be undertaken with this machine. Taken together, RPI technology has shown promising results, yet much more work is needed to determine if its theoretical potential to assess mechanical properties in vivo can be realized.

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“…The application of this micro‐destructive indentation test for fracture toughness determination in bone or cartilage tissue can become widespread because of simplicity, even if it does not give accurate fracture toughness values. For example, Coutts et al warned that in some samples, bone is too thin to support the high loads applied with the technique and in these cases, RPI values are highly influenced by thickness. Moreover, they suggested that RPI values vary significantly with test site; hence, mechanical properties should not be inferred from RPI findings alone away from the test site, even within the same bone.…”

Section: Bone and Cartilage Microindentation Analysismentioning

confidence: 99%

Assessment of Fracture Toughness in Bone Tissue Engineering

Nobile

2019

Polymer Engineering & Sci

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The fracture mechanisms affecting bone tissue can be described as a damage accumulation process due to the initiation and propagation of microcracks. Fracture risk does not solely depend on strength but also on fracture toughness. To replace damaged bone or cartilage tissues, hydrogels are required to provide appropriate stiffness or deformation properties as well as resistance to fracture. However, failure properties, such as the resistance to fracture, must be evaluated by fracture toughness techniques. Microindentation has emerged as a novel technique for the measurement of material properties of cortical bone. The application of this test for fracture toughness determination in these tissues can become widespread because of the simplicity of the test. The aims of this article are to discuss clinical application of fracture toughness analysis and to present a well tested and more realistic approach for estimating fracture toughness in bone. POLYM. ENG. SCI., 59:2402–2405, 2019. © 2019 Society of Plastics Engineers

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Variability in reference point microindentation and recommendations for testing cortical bone: Location, thickness and orientation heterogeneity

Cited by 18 publications

References 26 publications

Site-Dependent Reference Point Microindentation Complements Clinical Measures for Improved Fracture Risk Assessment at the Human Femoral Neck

Site-Dependent Reference Point Microindentation Complements Clinical Measures for Improved Fracture Risk Assessment at the Human Femoral Neck

True Gold or Pyrite: A Review of Reference Point Indentation for Assessing Bone Mechanical Properties In Vivo

Assessment of Fracture Toughness in Bone Tissue Engineering

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