Characterization of damage mechanisms associated with reference point indentation in human bone

Instrumented nanoindentation in musculoskeletal research

Musculoskeletal tissues, such as bone, cartilage, and muscle, are natural composite materials that are constructed with a hierarchical structure ranging from the cell to tissue level. The component differences and structural complexity, together, require comprehensive multiscale mechanical characterization. In this review, we focus on nanoindentation testing, which is used for nanometer to sub-micrometer length scale mechanical characterization. In the following context, we will summarize studies of nanoindentation in musculoskeletal research, examine the critical factors that affect nanoindentation testing results, and briefly summarize other commonly used techniques that can be conjoined with nanoindentation for synchronized imaging and colocalized characterization.

Methods for bone quality assessment in human bone tissue: a systematic review

Background

For biomechanical investigations on bone or bone implants, bone quality represents an important potential bias. Several techniques for assessing bone quality have been described in the literature. This study aims to systematically summarize the methods currently available for assessing bone quality in human bone tissue, and to discuss the advantages and limitations of these techniques.

Methods

A systematic review of the literature was carried out by searching the PubMed and Web of Science databases from January 2000 to April 2021. References will be screened and evaluated for eligibility by two independent reviewers as per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies must apply to bone quality assessment with imaging techniques, mechanical testing modalities, and compositional characterization. The terms used for the systematic search were: “(bone quality”. Ti,ab.) AND “(human bone specimens)”.

Results

The systematic review identified 502 relevant articles in total. Sixty-eight articles met the inclusion criteria. Among them, forty-seven articles investigated several imaging modalities, including radiography, dual-energy X-ray absorptiometry (DEXA), CT-based techniques, and MRI-based methods. Nineteen articles dealt with mechanical testing approaches, including traditional testing modalities and novel indentation techniques. Nine articles reported the correlation between bone quality and compositional characterization, such as degree of bone mineralization (DBM) and organic composition. A total of 2898 human cadaveric bone specimens were included.

Conclusions

Advanced techniques are playing an increasingly important role due to their multiple advantages, focusing on the assessment of bone morphology and microarchitecture. Non-invasive imaging modalities and mechanical testing techniques, as well as the assessment of bone composition, need to complement each other to provide comprehensive and ideal information on the bone quality of human bone specimens.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-022-03041-4.

Determination of Elastic Modulus in Mouse Bones Using a Nondestructive Micro-Indentation Technique Using Reference Point Indentation

The determination of the elastic modulus of bone is important in studying the response of bone to loading and is determined using a destructive three-point bending method. Reference point indentation (RPI), with one cycle of indentation, offers a nondestructive alternative to determine the elastic modulus. While the elastic modulus could be determined using a nondestructive procedure for ex vivo experiments, for in vivo testing, the three-point bending technique may not be practical and hence RPI is viewed as a potential alternative and explored in this study. Using the RPI measurements, total indentation distance (TID), creep indentation distance, indentation force, and the unloading slope, we have developed a numerical analysis procedure using the Oliver-Pharr (O/P) method to estimate the indentation elastic modulus. Two methods were used to determine the area function: (1) Oliver-Pharr (O/P-based on a numerical procedure) and (2) geometric (based on the calculation of the projected area of indentation). The indentation moduli of polymethyl methacrylate (PMMA) calculated by the O/P (3.49-3.68 GPa) and geometric (3.33-3.49 GPa) methods were similar to values in literature (3.5-4 GPa). In a study using femurs from C57Bl/6 mice of different ages and genders, the three-point bending modulus was lower than the indentation modulus. In femurs from 4 to 5 months old TOPGAL mice, we found that the indentation modulus from the geometric (5.61 ± 1.25 GPa) and O/P (5.53 ± 1.27 GPa) methods was higher than the three-point bending modulus (5.28 ± 0.34 GPa). In females, the indentation modulus from the geometric (7.45 ± 0.86 GPa) and O/P (7.46 ± 0.92 GPa) methods was also higher than the three-point bending modulus (7.33 ± 1.13 GPa). We can conclude from this study that the RPI determined values are relatively close to three-point bending values.

Improved RANKL expression and osteoclastogenesis induction of CD27+CD38- memory B cells: A link between B cells and alveolar bone damage in periodontitis

BACKGROUND AND OBJECTIVE

Periodontitis is a bacteria-induced disease that often leads to alveolar bone damage. Its mechanisms were considered to be complicated, involving an imbalance of the formation and resorption of bone. We sought to disclose the antibody-independent function of B cells during periodontitis.

MATERIAL AND METHODS

Production of receptor activator for nuclear factor-κB ligand (RANKL) by total lymphocytes or sorted B-cell subsets in gingiva from healthy or experimental periodontitis animals was examined by flow cytometry, real-time polymerase chain reaction, and enzyme-linked immunosorbent assay. To define the effects of lymphocytes or B-cell subsets on osteoclastogenesis induction, bone marrow mononuclear cells were culture in culture medium of lymphocytes or cocultured with B-cell subsets. Osteoclasts were enumerated by tartrate-resistant acid phosphatase staining. Constituent ratio of B-cell subsets in healthy or experimental periodontitis was also detected by flow cytometry.

RESULT

Gingiva B cells produce more RANKL and support more osteoclastogenesis than T and other lymphocytes, and this potential improved in periodontitis. Memory B cells (CD27+CD38-) decreased their percentage in periodontitis. Memory B cells have the highest propensity for RANKL production. Remarkably, memory B cells from periodontitis animals expressed significantly more RANKL compared to healthy controls. Memory B cells supported osteoclast differentiation in vitro in a RANKL-dependent manner, and the number of osteoclasts was higher in cultures with memory B cells from periodontitis animals than in those derived from healthy ones. Other B-cell subsets have limited impact on osteoclast formation.

CONCLUSION

Findings of this study further disclose the roles of B cells engaged in periodontal immunomodulation and reveal the considerable importance of memory B cells in alveolar bone homeostasis and their likely contribution to alveolar bone destruction in periodontitis.

The inferomedial femoral neck is compromised by age but not disease: Fracture toughness and the multifactorial mechanisms comprising reference point microindentation

The influence of ageing on the fracture mechanics of cortical bone tissue is well documented, though little is known about if and how related material properties are further affected in two of the most prominent musculoskeletal diseases, osteoporosis and osteoarthritis (OA). The femoral neck, in close proximity to the most pertinent osteoporotic fracture site and near the hip joint affected by osteoarthritis, is a site of particular interest for investigation. We have recently shown that Reference Point micro-Indentation (RPI) detects differences between cortical bone from the femoral neck of healthy, osteoporotic fractured and osteoarthritic hip replacement patients. RPI is a new technique with potential for in vivo bone quality assessment. However, interpretation of RPI results is limited because the specific changes in bone properties with pathology are not well understood and, further, because it is not conclusive what properties are being assessed by RPI. Here, we investigate whether the differences previously detected between healthy and diseased cortical bone from the femoral neck might reflect changes in fracture toughness. Together with this, we investigate which additional properties are reflected in RPI measures. RPI (using the Biodent device) and fracture toughness tests were conducted on samples from the inferomedial neck of bone resected from donors with: OA (41 samples from 15 donors), osteoporosis (48 samples from 14 donors) and non age-matched cadaveric controls (37 samples from 10 donoros) with no history of bone disease. Further, a subset of indented samples were imaged using micro-computed tomography (3 osteoporotic and 4 control samples each from different donors) as well as fluorescence microscopy in combination with serial sectioning after basic fuchsin staining (7 osteoporotic and 5 control samples from 5 osteoporotic and 5 control donors). In this study, the bulk indentation and fracture resistance properties of the inferomedial femoral neck in osteoporotic fracture, severe OA and control bone were comparable (p > 0.05 for fracture properties and <10% difference for indentation) but fracture toughness reduced with advancing age (7.0% per decade, r = -0.36, p = 0.029). Further, RPI properties (in particular, the indentation distance increase, IDI) showed partial correlation with fracture toughness (r = -0.40, p = 0.023) or derived elastic modulus (r = -0.40, p = 0.023). Multimodal indent imaging revealed evidence of toughening mechanisms (i.e. crack deflection, bridging and microcracking), elastoplastic response (in terms of the non-conical imprint shape and presence of pile-up) and correlation of RPI with damage extent (up to r = 0.79, p = 0.034) and indent size (up to r = 0.82, p < 0.001). Therefore, crack resistance, deformation resistance and, additionally, micro-structure (porosity: r = 0.93, p = 0.002 as well as pore proximity: r = -0.55, p = 0.027 for correlation with IDI) are all contributory to RPI. Consequently, it becomes clear that RPI measures represent a multitude of properties, various aspects of bone quality, but are not necessarily strongly correlated to a single mechanical property. In addition, osteoporosis or osteoarthritis do not seem to further influence fracture toughness of the inferomedial femoral neck beyond natural ageing. Since bone is highly heterogeneous, whether this finding can be extended to the whole femoral neck or whether it also holds true for other femoral neck quadrants or other material properties remains to be shown.

Microindentation - a tool for measuring cortical bone stiffness? A systematic review

Objectives

Microindentation has the potential to measure the stiffness of an individual patient’s bone. Bone stiffness plays a crucial role in the press-fit stability of orthopaedic implants. Arming surgeons with accurate bone stiffness information may reduce surgical complications including periprosthetic fractures. The question addressed with this systematic review is whether microindentation can accurately measure cortical bone stiffness.

Methods

A systematic review of all English language articles using a keyword search was undertaken using Medline, Embase, PubMed, Scopus and Cochrane databases. Studies that only used nanoindentation, cancellous bone or animal tissue were excluded.

Results

A total of 1094 abstracts were retrieved and 32 papers were included in the analysis, 20 of which used reference point indentation, and 12 of which used traditional depth-sensing indentation. There are several factors that must be considered when using microindentation, such as tip size, depth and method of analysis. Only two studies validated microindentation against traditional mechanical testing techniques. Both studies used reference point indentation (RPI), with one showing that RPI parameters correlate well with mechanical testing, but the other suggested that they do not.

Conclusion

Microindentation has been used in various studies to assess bone stiffness, but only two studies with conflicting results compared microindentation with traditional mechanical testing techniques. Further research, including more studies comparing microindentation with other mechanical testing methods, is needed before microindentation can be used reliably to calculate cortical bone stiffness.

Cite this article: M. Arnold, S. Zhao, S. Ma, F. Giuliani, U. Hansen, J. P. Cobb, R. L. Abel, O. Boughton. Microindentation – a tool for measuring cortical bone stiffness? A systematic review. Bone Joint Res 2017;6:542–549. DOI: 10.1302/2046-3758.69.BJR-2016-0317.R2.

Microdamage induced by in vivo Reference Point Indentation in mice is repaired by osteocyte-apoptosis mediated remodeling

Reference Point Indentation (RPI) is a technology that is designed to measure mechanical properties that relate to bone toughness, or its ability to resist crack growth, in vivo. Independent of the mechanical parameters generated by RPI, its ability to initiate and propagate microcracks in bone is itself an interesting issue. Microcracks have a crucial biological relevance in bone, are central to its ability to maintain homeostasis. In healthy tissues, a process of targeted remodeling routinely repairs microcracks in a process mediated by osteocyte apoptosis. However, in diseases such as osteoporosis this process becomes deficient and microcracks can accumulate. Small animal models such are crucial for the study of such diseases, but it is technically challenging to create microcracks in these animals without causing outright failure. Therefore we sought to use RPI as a focal microdamage placement tool, to introduce microcracks to mouse long bones and investigate whether the same pathway mediates their repair as that described in other microdamage systems. We first used SEM to confirm that microdamage is formed RPI in mouse bone. Then, since RPI is carried out transdermally, we sought to confirm that no periosteal response occurred at the indented region. We then used a pan-caspase inhibitor (QVD) to determine whether osteocyte apoptosis plays the same pivotal role in microdamage repair in this model, as has been demonstrated in others. In conclusion, we validated that the microdamage-apoptosis-remodeling pathway is maintained with this method of microdamage induction in mice. We show that RPI can be used as a reliable and reproducible microdamage placement tool in living mouse long bones without inducing a periosteal response. We also used a caspase inhibitor, to block osteocyte apoptosis and thus abrogate the remodeling response to microdamage. This demonstrates that the well described microdamage repair system, involving targeted remodeling mediated by osteocyte apoptosis, is conserved in this novel mouse model using an in vivo RPI loading system.

Finite element simulation of Reference Point Indentation on bone

Reference Point Indentation (RPI) is a novel technique aimed to assess bone quality. Measurements are recorded by the BioDent instrument that applies multiple indents to the same location of cortical bone. Ten RPI parameters are obtained from the resulting force-displacement curves. Using the commercial finite element analysis software Abaqus, we assess the significance of the RPI parameters. We create an axisymmetric model and employ an isotropic viscoelastic-plastic constitutive relation with damage to simulate indentations on a human cortical bone. Fracture of bone tissue is not simulated for simplicity. The RPI outputs are computed for different simulated test cases and then compared with experimental results, measured using the BioDent, found in literature. The number of cycles, maximum indentation load, indenter tip radius, and the mechanical properties of bone: Young׳s modulus, compressive yield stress, and viscosity and damage constants, are varied. The trends in the RPI parameters are then investigated. We find that the RPI parameters are sensitive to the mechanical properties of bone. An increase in Young׳s modulus of bone causes the force-displacement loading and unloading slopes to increase and the total indentation distance (TID) to decrease. The compressive yield stress is inversely proportional to a creep indentation distance (CID1) and the TID. The viscosity constant is proportional to the CID1 and an average of the energy dissipated (AvED). The maximum indentation load is proportional to the TID, CID1, loading and unloading slopes, and AvED. The damage parameter is proportional to the TID, but it is inversely proportional to both the loading and unloading slopes and the AvED. The value of an indenter tip radius is proportional to the CID1 and inversely proportional to the TID. The number of load cycles is inversely proportional to an average of a creep indentation depth (AvCID) and the AvED. The indentation distance increase (IDI) is strongly inversely proportional to the compressive yield stress, and strongly proportional to the viscosity constant and maximum applied load, but has weak relation with the damage parameter, indenter tip radius, and elastic modulus. This computational study advances our understanding of the RPI outputs and provides a starting point for more comprehensive computational studies of the RPI technique.

Assessing the inter- and intra-animal variability of in vivo OsteoProbe skeletal measures in untreated dogs

The OsteoProbe is a second-generation reference point indentation (RPI) device without a reference probe that is designed to simplify RPI testing for clinical use. Successful clinical implementation of the OsteoProbe would benefit from a better understanding of how its output, bone material strength index (BMSi), relates to the material properties of bone and under what conditions it reliably correlates with fracture risk. Large animal models have the potential to help fill this knowledge gap, as cadaveric studies are retrospective and limited by incomplete patient histories (including the potential use of bone matrix altering drugs such as bisphosphonates). The goal of this study was to assess the intra and inter-animal variability of OsteoProbe measures in untreated beagle dogs (n = 12), and to evaluate this variability in comparison to traditional mechanical testing. OsteoProbe measurements were performed in vivo on the left tibia of each dog and repeated 6 months later on the day of sacrifice. Within-animal variation of BMSi (CV of 5–10 indents) averaged 8.9 and 9.0% at the first and second timepoints, respectively. In contrast, inter-animal variation of BMSi increased from 5.3% to 9.1%. The group variation of BMSi was on par with that of traditional 3-point mechanical testing; inter-animal variation was 10% for ultimate force, 13% for stiffness, and 12% for total work as measured on the femur. There was no significant change in mean BMSi after 6 months, but the individual change with time across the 12 dogs was highly variable, ranging from − 12.4% to + 21.7% (mean 1.6%, SD 10.6%). No significant correlations were found between in vivo tibia BMSi and femur mechanical properties measured by ex vivo 3-pt bending, but this may be a limitation of sample size or the tests being performed on different bones. No relationship was found between BMSi and tissue mineral density, but a strong positive correlation was found between BMSi and tibia cortical thickness (ρ = 0.706, p = 0.010). This report shows that while the OsteoProbe device has inter-individual variability quite similar to that of traditional mechanical testing, the longitudinal changes show high levels of heterogeneity across subjects. We further highlight the need for standardization in post-testing data processing and further study of the relationships between OsteoProbe and traditional mechanical testing.

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OsteoProbe bone material strength index (BMSi) was assessed in female beagle dogs.

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The inter-subject variance of BMSi was comparable to traditional mechanical tests.

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Longitudinal changes in BMSi over 6 months were heterogeneous across subjects.

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Femur mechanical properties measured by bending did not correlate with tibia BMSi.

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The need for standardization of OsteoProbe post-test data processing is discussed.

Label-Free and Sensitive Detection of BRCA1 and TB4 DNA Sequences with Water-Soluble Cationic Polythiophenes

A sensitive method for BRCA1 and TB4 DNA sequences detection using water-soluble cationic polythiophenes, poly(3-(1′-ethoxy-2′-N-methyl imidazole)thiophene) (PT) is presented. The fluorescence of PT could be dramatically quenched by the addition of single-stranded DNA (ssDNA; TB4 and BRCA1 sequences). The KSV (Stern–Volmer constant) for TB4 and BRCA1 DNA sequences are 1.46 × 108 and 3.28 × 108 M–1 respectively, and the limits of detection of these two sequences are 1.26 × 10–10 and 0.483 × 10–10 M respectively. The fluorescence of PT would recover to its initial intensity after the addition of complementary ssDNA, whereas sequences with one to three mismatched bases would not. The influences of buffer pH and concentration of NaCl were also investigated systemically in order to further improve the sensitivity. This assay can be completed in a short period of time without any further procedure. Hence, this sensitive, cost-effective, and rapid detection method for BRCA1 and TB4 DNA sequences may contribute to the clinical diagnosis of breast cancer gene mutations in the future.

A novel technique for micro-hole forming on skull with the assistance of ultrasonic vibration

Micro-hole opening on skull is technically challenging and is hard to realize by micro-drilling. Low-stiffness of the drill bit is a serious drawback in micro-drilling. To deal with this problem, a novel ultrasonic vibration assisted micro-hole forming technique has been developed. Tip geometry and vibration amplitude are two key factors affecting the performance of this hole forming technique. To investigate their effects, experiment was carried out with 300μm diameter tools of three different tip geometries at three different vibration amplitudes. Hole forming performance was evaluated by the required thrust force, dimensional accuracy, exit burr and micro-structure of bone tissue around the generated hole. Based on the findings from current study, the 60° conically tipped tool helps generate a micro-hole of better quality at a smaller thrust force, and it is more suitable for hole forming than the 120° conically tipped tool and the blunt tipped tool. As for the vibration amplitude, when a larger amplitude is used, a micro-hole of better quality and higher dimensional accuracy can be formed at a smaller thrust force. Findings from this study would lay a technical foundation for accurately generating a high-quality micro-hole on skull, which enables minimally invasive insertion of a microelectrode into brain for neural activity measuring.

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

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 been utilized in several publications. In this review we present an overview of 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 nonfracture 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.