Connectivity and the elastic properties of cancellous bone

A morphological, topological and mechanical investigation of gyroid, spinodoid and dual-lattice algorithms as structural models of trabecular bone

In this study, we evaluate the performance of three algorithms as computational models of trabecular bone architecture, through systematic evaluation of morphometric, topological, and mechanical properties. Here, we consider the widely-used gyroid lattice structure, the recently-developed spinodoid structure and a structure similar to Voronoi lattices introduced here as the dual-lattice. While all computational models were calibrated to recreate the trabecular tissue volume (e.g. BV/TV), it was found that both the gyroid- and spinodoid-based structures showed substantial differences in many other morphometric and topological parameters and, in turn, showed lower effective mechanical properties compared to trabecular bone. The newly-developed dual-lattice structures better captured both morphometric parameters and mechanical properties, despite certain differences being evident their topological configuration compared to trabecular bone. Still, these computational algorithms provide useful platforms to investigate trabecular bone mechanics and for designing biomimetic structures, which could be produced through additive manufacturing for applications that include bone substitutes, scaffolds and porous implants. Furthermore, the software for the creation of the structures has been added to the open source toolbox GIBBON and is therefore freely available to the community.

Impact of the training loss in deep learning based CT reconstruction of bone microarchitecture

PURPOSE

Computed tomography (CT) is a technique of choice to image bone structure at different scales. Methods to enhance the quality of degraded reconstructions obtained from low-dose CT data have shown impressive results recently, especially in the realm of supervised deep learning. As the choice of the loss function affects the reconstruction quality, it is necessary to focus on the way neural networks evaluate the correspondence between predicted and target images during the training stage. This is even more true in the case of bone microarchitecture imaging at high spatial resolution where both the quantitative analysis of Bone Mineral Density (BMD) and bone microstructure are essential for assessing diseases such as osteoporosis. Our aim is thus to evaluate the quality of reconstruction on key metrics for diagnosis depending on the loss function that has been used for training the neural network.

METHODS

We compare and analyze volumes that are reconstructed with neural networks trained with pixelwise, structural and adversarial loss functions or with a combination of them. We perform realistic simulations of various low-dose acquisitions of bone microarchitecture. Our comparative study is performed with metrics that have an interest regarding the diagnosis of bone diseases. We therefore focus on bone-specific metrics such as BV/TV, resolution, connectivity assessed with the Euler number and quantitative analysis of BMD to evaluate the quality of reconstruction obtained with networks trained with the different loss functions.

RESULTS

We find that using L₁ norm as the pixelwise loss is the best choice compared to L₂ or no pixelwise loss since it improves resolution without deteriorating other metrics. VGG perceptual loss, especially when combined with an adversarial loss, allows to better retrieve topological and morphological parameters of bone microarchitecture compared to SSIM. This however leads to a decreased resolution performance. The adversarial loss enchances the reconstruction performance in terms of BMD distribution accuracy.

CONCLUSIONS

In order to retrieve the quantitative and structural characteristics of bone microarchitecture that are essential for post-reconstruction diagnosis, our results suggest to use L₁ norm as part of the loss function. Then, trade-offs should be made depending on the application: VGG perceptual loss improves accuracy in terms of connectivity at the cost of a deteriorated resolution, and adversarial losses help better retrieve BMD distribution while significantly increasing the training time. This article is protected by copyright. All rights reserved.

The Effect of Bone Marrow Stimulation for Cartilage Repair on the Subchondral Bone Plate

PURPOSE

To investigate the effect of bone-marrow stimulation (BMS) on subchondral bone plate morphology and remodeling compared to untreated subchondral bone in a validated minipig model.

METHODS

Three Göttingen minipigs received BMS with drilling as treatment for two chondral defects in each knee. The animals were euthanized after six months. Follow-up consisted of a histological semiquantitative evaluation using a novel subchondral bone scoring system and micro computed tomography (µCT) of the BMS subchondral bone. The histological and microstructural properties of the BMS-treated subchondral bone were compared to that of the adjacent healthy subchondral bone.

RESULTS

The µCT analysis showed that subchondral bone treated with BMS had significantly higher connectivity density compared to adjacent untreated subchondral bone (26 1/mm³ vs. 21 1/mm³, P = 0.048). This was the only microstructural parameter showing a significant difference. The histological semiquantitative score differed significantly between the subchondral bone treated with BMS and the adjacent untreated subchondral (8.0 vs. 10 P = < 0.001). Surface irregularities were seen in 43% and bone overgrowth in 27% of the histological sections. Only sparse formation of bone cysts was detected (1%).

CONCLUSIONS

BMS with drilling does not cause extensive changes to the subchondral bone microarchitecture. Furthermore, the morphology of BMS subchondral bone resembled that of untreated subchondral bone with almost no formation of bone cyst, but some surface irregularities and bone overgrowth.

Micro-CT-Based Bone Microarchitecture Analysis of the Murine Skull

X-ray micro-computed tomography (micro-CT) imaging has important applications in microarchitecture analysis of cortical and trabecular bone structure. While standardized protocols exist for micro-CT-based microarchitecture assessment of long bones, specific protocols need to be developed for different types of skull bones taking into account differences in embryogenesis, organization, development, and growth compared to the rest of the body. This chapter describes the general principles of bone microarchitecture analysis of murine craniofacial skeleton to accommodate for morphological variations in different regions of interest.

The bone microstructure from anterior cruciate ligament footprints is similar after ligament reconstruction and does not affect long-term outcomes

PURPOSE

The purpose of this study was to assess the quality of the bone tissue microstructure from the footprints of the anterior cruciate ligament (ACL) and its impact on late follow-up outcomes in patients who undergo anterior cruciate ligament reconstruction (ACLR).

METHODS

The records of 26 patients diagnosed with a completely torn ACL who underwent ACLR were collected. During the surgery performed using the Felmet method, bone blocks from the native ACL footprints were collected. The primary measurements of the bone microstructure were made using a microtomographic scanner. In late follow-up examinations, a GNRB arthrometer was used.

RESULTS

There was no significant difference in the bone microstructure assessed using micro-CT histomorphometric data according to the blood test results, plain radiographs, age or anthropometric data. There was no difference in the bone volume/total volume ratio or trabecular thickness in the area of the native ACL footprints. Routine preoperative examinations were not relevant to the quality of the bone microstructure. The elapsed time from an ACL injury to surgery had no relevance to the results of arthrometry.

CONCLUSION

The similarities in the microstructure of bone blocks from ACL footprints from the femur and tibia allow the variable use of these blocks to stabilize grafts in the Felmet method. The bone microstructure is not dependent on the time from injury to surgery. Histomorphometric values of the structure of the femoral and tibial ACL footprints have no impact on the long-term stability of the operated knee joint.

TRIAL REGISTRATION

The approval of the Bioethics Committee of the Silesian Medical Chamber in Katowice, Poland (resolution 16/2014) was given for this research.

LEVEL OF EVIDENCE

II.

Novel strategies for the characterization of cancellous bone morphology: Virtual isolation and analysis

OBJECTIVES

The advent of micro-computed tomography (μCT) made cancellous bone more accessible than ever before. Nevertheless, the characterization of cancellous bone is made difficult by its inherent complexity and the difficulties in defining homology across datasets. Here we propose novel virtual methodological approaches to overcome those issues and complement existing methods.

MATERIALS AND METHODS

We present a protocol for the isolation of the whole cancellous region within a μCT scanned bone. This method overcomes the subsampling issues and allows studying cancellous bone as a single unit. We test the protocol on a set of primate bones. In addition, we describe a set of morphological indices calculated on the topological skeleton of the cancellous bone: node density, node connectivity, trabecular angle, trabecular tortuosity, and fractal dimension. The usage of the indices is shown on a small comparative sample of primate femoral heads.

RESULTS

The isolation protocol proves reliable in isolating cancellous structures from several different bones, regardless of their shape. The indices seem to detect some functional differences, although further testing on comparative samples is needed to clarify their potential for the study of cancellous architecture.

CONCLUSIONS

The approaches presented overcome some of the difficulties of trabecular bone studies. The methods presented here represent an alternative or supporting method to the existing tools available to address the biomechanics of cancellous bone.

Microarchitecture of cetacean vertebral trabecular bone among swimming modes and diving behaviors

Cetaceans (dolphins, whales, and porpoises) are fully aquatic mammals that are supported by water's buoyancy and swim through axial body bending. Swimming is partially mediated by variations in vertebral morphology that creates trade-offs in body flexibility and rigidity between axial regions that either enhance or reduce displacement between adjacent vertebrae. Swimming behavior is linked to foraging ecology, where deep-diving cetaceans glide a greater proportion of the time compared to their shallow-diving counterparts. In this study, we categorized 10 species of cetaceans (Families Delphinidae and Kogiidae) into functional groups determined by swimming patterns (rigid vs. flexible torso) and diving behavior (shallow vs. deep). Here, we quantify vertebral trabecular microarchitecture (a) among functional groups (rigid-torso shallow diver (RS), rigid-torso deep diver (RD), and flexible-torso deep diver (FD)), and (b) among vertebral column regions (posterior thoracic, lumbar, caudal peduncle, and fluke insertion). We microCT scanned vertebral bodies, from which 1-5 volumes of interest were selected to quantify bone volume fraction (BV/TV), specific bone surface (BS/BV), trabecular thickness (TbTh), trabecular number (TbN), trabecular separation (TbSp), and degree of anisotropy (DA). We found that BV/TV was greatest in the rigid-torso shallow-diving functional group, smallest in flexible-torso deep-diving species, and intermediate in the rigid-torso deep-diving group. DA was significantly greater in rigid-torso caudal oscillators than in their flexible-torso counterparts. We found no variation among vertebral regions for any microarchitectural variables. Despite having osteoporotic skeletons, cetacean vertebrae had greater BV/TV, TbTh, and DA than previously documented in terrestrial mammalian bone. Cetacean species are an ideal model to investigate the long-term adaptations, over an animal's lifetime and over evolutionary time, of trabecular bone in non-weight-bearing conditions.

Prediction of trabecular bone architectural features by deep learning models using simulated DXA images

Dual-energy X-ray absorptiometry (DXA) is widely used for clinical assessment of bone mineral density (BMD). Recent evidence shows that DXA images may also contain microstructural information of trabecular bones. However, no current image processing techniques could aptly extract the information. Inspired by the success of deep learning techniques in medical image analyses, we hypothesized in this study that DXA image-based deep learning models could predict the major microstructural features of trabecular bone with a reasonable accuracy. To test the hypothesis, 1249 trabecular cubes (6 mm × 6 mm × 6 mm) were digitally dissected out from the reconstruction of seven human cadaveric proximal femurs using microCT scans. From each cube, simulated DXA images in designated projections were generated, and the histomorphometric parameters (i.e., BV/TV, BS, Tb.Th, DA, Conn. D, and SMI) of the cube were determined using Image J. Convolutional neural network (CNN) models were trained using the simulated DXA images to predict the histomorphometric parameters of trabecular bone cubes. The results exhibited that the CNN models achieved high fidelity in predicting these histomorphometric parameters (from R = 0.80 to R = 0.985), showing that the DL models exhibited the capability of predicting the microstructural features using DXA images. This study also showed that the number and resolution of input simulated DXA images had considerable impacts on the prediction accuracy of the DL models. These findings support the hypothesis of this study and indicate a high potential of using DXA images in prediction of osteoporotic bone fracture risk.

Subchondral focal osteopenia associated with proximal sesamoid bone fracture in Thoroughbred racehorses

BACKGROUND

Proximal sesamoid bone (PSB) fracture is the most common fatal injury in Thoroughbred (TB) racehorses in the United States. Epidemiological and pathological evidence indicates PSB fracture is likely the acute culmination of a chronic stress-related process. However, the aetiopathogenesis of PSB fracture is poorly understood.

OBJECTIVE

To characterise bone abnormalities that precede PSB fracture.

STUDY DESIGN

Two retrospective case-control groups of PSBs from TB racehorses with, and without, unilateral biaxial PSB fracture.

METHODS

Proximal sesamoid bones were harvested post-mortem from TB racehorses subjected to euthanasia for unilateral biaxial PSB fracture (cases) or causes unrelated to PSB fracture (controls) while racing or training. The fractured medial PSB (FX-PSB) and contralateral intact medial PSB (CLI-PSB) from racehorses that sustained PSB fracture, and an intact medial PSB (CTRL-PSB) from racehorses that did not have a PSB fracture were collected as case and control specimens. Study 1 distributions of morphological features were compared among case and control groups using visual examination, photographs, radiographs and histology of whole PSBs and serial sagittal sections (10 FX-PSB, 10 CLI-PSB and 10 CTRL-PSB). Study 2 local bone volume fraction and mineral densities were compared among case and control PSBs using microcomputed tomography (9 FX-PSB, 9 CLI-PSB and 9 CTRL-PSB).

RESULTS

A focal subchondral lesion characterised by colocalised focal discoloration, radiolucency, osteopenia, low tissue mineral density and a surrounding region of dense cancellous bone was identified in most case horses but not in controls. This subchondral lesion was found in a slightly abaxial mid-body location and was bilaterally present in most case horses.

MAIN LIMITATIONS

The post-mortem samples may not represent the spectrum of abnormalities that occur throughout the development of the subchondral lesion. Lateral PSBs were not examined, so their contribution to biaxial PSB fracture pathogenesis is unknown.

CONCLUSION

Abaxial subchondral lesions are consistent with pre-existing injury and likely associated with PSB fracture.

Effects of condensation and compressive strain on implant primary stability: A longitudinal, in vivo, multiscale study in mice

Aims

Surgeons and most engineers believe that bone compaction improves implant primary stability without causing undue damage to the bone itself. In this study, we developed a murine distal femoral implant model and tested this dogma.

Methods

Each mouse received two femoral implants, one placed into a site prepared by drilling and the other into the contralateral site prepared by drilling followed by stepwise condensation.

Results

Condensation significantly increased peri-implant bone density but it also produced higher strains at the interface between the bone and implant, which led to significantly more bone microdamage. Despite increased peri-implant bone density, condensation did not improve implant primary stability as measured by an in vivo lateral stability test. Ultimately, the condensed bone underwent resorption, which delayed the onset of new bone formation around the implant.

Conclusion

Collectively, these multiscale analyses demonstrate that condensation does not positively contribute to implant stability or to new peri-implant bone formation.

Cite this article:Bone Joint Res. 2020;9(2):60–70.

Multiscale design of artificial bones with biomimetic elastic microstructures

Cancellous bone is a highly porous, heterogeneous, and anisotropic material which can be found at the epiphyses of long bones and in the vertebral bodies. The hierarchical architecture makes cancellous bone a prime example of a lightweight natural material that combines strength with toughness. Better understanding the mechanics of cancellous bone is of interest for the diagnosis of bone diseases, the evaluation of the risk of fracture, and for the design of artificial bones and bone scaffolds for tissue engineering. A multiscale optimization method to maximize the stiffness of artificial bones using biomimetic cellular microstructures described by a finite set of geometrical micro-parameters is presented here. The most outstanding characteristics of its implementation are the use of: an interior point optimization algorithm, a precalculated response surface methodology for the evaluation of the elastic tensor of the microstructure as an analytical function of the micro-parameters, and the adjoint method for the computation of the sensitivity of the macroscopic mechanical response to the variation of the micro-parameters. The performance and effectiveness of the tool are evaluated by solving a problem that consists in finding the optimal distribution of the microstructures for a proximal end of a femur subjected to physiological loads. Two strategies for the specification of the solid volume fraction constraints are assessed. The results are compared with data of a computed tomography study of an actual human bone. The model successfully predicts the main features of the spatial arrangement of the trabecular and cortical microstructures of the natural bone.

Effect of Systemic Oxytocin Administration on New Bone Formation and Distraction Rate in Rabbit Mandible

PURPOSE

The main disadvantage of distraction osteogenesis is the prolonged treatment protocol. Recently, oxytocin (OT) has been found to have anabolic effects on bone metabolism. In this experimental study, the effects of OT on the mandibular distraction gap in rabbits at 2 different distraction rates were evaluated.

MATERIALS AND METHODS

This experimental study was conducted on 28 male New Zealand white rabbits. The animals were divided into 3 experimental groups and 1 control group. Group A (control group, n = 7) consisted of animals with distraction at a rate of 1 mm/day, and group B (n = 7) consisted of animals with a distraction rate of 2 mm/day; groups A and B received postoperative saline solution injection. Group C (n = 7) consisted of animals with distraction at a rate of 1 mm/day, and group D (n = 7) consisted of animals with a distraction rate of 2 mm/day; postoperative OT injection was performed in groups C and D.

RESULTS

Both histomorphologic and micro-computed tomography evaluations showed increased bone healing in the OT-treated groups.

CONCLUSIONS

On the basis of the evaluation of both the histomorphometric and micro-computed tomographic data, systemic OT administration was found to increase new bone formation and bone healing with distraction osteogenesis.

Material properties of human lumbar intervertebral discs across strain rates

BACKGROUND CONTEXT

The use of finite element (FE) methods to study the biomechanics of the intervertebral disc (IVD) has increased over recent decades due to their ability to quantify internal stresses and strains throughout the tissue. Their accuracy is dependent upon realistic, strain-rate dependent material properties, which are challenging to acquire.

PURPOSE

The aim of this study was to use the inverse FE technique to characterize the material properties of human lumbar IVDs across strain rates.

STUDY DESIGN

A human cadaveric experimental study coupled with an inverse finite element study.

METHODS

To predict the structural response of the IVD accurately, the material response of the constituent structures was required. Therefore, compressive experiments were conducted on 16 lumbar IVDs (39±19 years) to obtain the structural response. An FE model of each of these experiments was developed and then run through an inverse FE algorithm to obtain subject-specific constituent material properties, such that the structural response was accurate.

RESULTS

Experimentally, a log-linear relationship between IVD stiffness and strain rate was observed. The material properties obtained through the subject-specific inverse FE optimization of the annulus fibrosus (AF) fiber and AF fiber ground matrix allowed a good match between the experimental and FE response. This resulted in a Young modulus of AF fibers (-MPa) to strain rate (ε˙, /s) relationship of YMAF=31.5ln(ε˙)+435.5, and the C₁₀ parameter of the Neo-Hookean material model of the AF ground matrix was found to be strain-rate independent with an average value of 0.68 MPa.

CONCLUSIONS

These material properties can be used to improve the accuracy, and therefore predictive ability of FE models of the spine that are used in a wide range of research areas and clinical applications.

CLINICAL SIGNIFICANCE

Finite element models can be used for many applications including investigating low back pain, spinal deformities, injury biomechanics, implant design, design of protective systems, and degenerative disc disease. The accurate material properties obtained in this study will improve the predictive ability, and therefore clinical significance of these models.

Trabecular architecture and joint loading of the proximal humerus in extant hominoids, Ateles, and Australopithecus africanus

OBJECTIVES

Several studies have investigated potential functional signals in the trabecular structure of the primate proximal humerus but with varied success. Here, we apply for the first time a "whole-epiphyses" approach to analysing trabecular bone in the humeral head with the aim of providing a more holistic interpretation of trabecular variation in relation to habitual locomotor or manipulative behaviors in several extant primates and Australopithecus africanus.

MATERIALS AND METHODS

We use a "whole-epiphysis" methodology in comparison to the traditional volume of interest (VOI) approach to investigate variation in trabecular structure and joint loading in the proximal humerus of extant hominoids, Ateles and A. africanus (StW 328).

RESULTS

There are important differences in the quantification of trabecular parameters using a "whole-epiphysis" versus a VOI-based approach. Variation in trabecular structure across knuckle-walking African apes, suspensory taxa, and modern humans was generally consistent with predictions of load magnitude and inferred joint posture during habitual behaviors. Higher relative trabecular bone volume and more isotropic trabeculae in StW 328 suggest A. africanus may have still used its forelimbs for arboreal locomotion.

DISCUSSION

A whole-epiphysis approach to analysing trabecular structure of the proximal humerus can help distinguish functional signals of joint loading across extant primates and can provide novel insight into habitual behaviors of fossil hominins.

Bone volume fraction and structural parameters for estimation of mechanical stiffness and failure load of human cancellous bone samples; in-vitro comparison of ultrasound transit time spectroscopy and X-ray μCT

Conventional mechanical testing is the 'gold standard' for assessing the stiffness (N mm^-1) and strength (MPa) of bone, although it is not applicable in-vivo since it is inherently invasive and destructive. The mechanical integrity of a bone is determined by its quantity and quality; being related primarily to bone density and structure respectively. Several non-destructive, non-invasive, in-vivo techniques have been developed and clinically implemented to estimate bone density, both areal (dual-energy X-ray absorptiometry (DXA)) and volumetric (quantitative computed tomography (QCT)). Quantitative ultrasound (QUS) parameters of velocity and attenuation are dependent upon both bone quantity and bone quality, although it has not been possible to date to transpose one particular QUS parameter into separate estimates of quantity and quality. It has recently been shown that ultrasound transit time spectroscopy (UTTS) may provide an accurate estimate of bone density and hence quantity. We hypothesised that UTTS also has the potential to provide an estimate of bone structure and hence quality. In this in-vitro study, 16 human femoral bone samples were tested utilising three techniques; UTTS, micro computed tomography (μCT), and mechanical testing. UTTS was utilised to estimate bone volume fraction (BV/TV) and two novel structural parameters, inter-quartile range of the derived transit time (UTTS-IQR) and the transit time of maximum proportion of sonic-rays (TTMP). μCT was utilised to derive BV/TV along with several bone structure parameters. A destructive mechanical test was utilised to measure the stiffness and strength (failure load) of the bone samples. BV/TV was calculated from the derived transit time spectrum (TTS); the correlation coefficient (R²) with μCT-BV/TV was 0.885. For predicting mechanical stiffness and strength, BV/TV derived by both μCT and UTTS provided the strongest correlation with mechanical stiffness (R²=0.567 and 0.618 respectively) and mechanical strength (R²=0.747 and 0.736 respectively). When respective structural parameters were incorporated to BV/TV, multiple regression analysis indicated that none of the μCT histomorphometric parameters could improve the prediction of mechanical stiffness and strength, while for UTTS, adding TTMP to BV/TV increased the prediction of mechanical stiffness to R²=0.711 and strength to R²=0.827. It is therefore envisaged that UTTS may have the ability to estimate BV/TV along with providing an improved prediction of osteoporotic fracture risk, within routine clinical practice in the future.

Biophysical regulation of osteotomy healing: An animal study

BACKGROUND

Osteotomies have been performed for centuries yet there remains a remarkable lack of consensus on optimal methods for cutting bone. There is universal agreement, however, that preserving cell viability is critical.

PURPOSE

To identify mechanobiological parameters influencing bone formation after osteotomy site preparation.

MATERIALS AND METHODS

A murine maxillary osteotomy model was used to evaluate healing. Computational modeling characterized stress and strain distributions in the osteotomy, as well as the magnitude and distribution of heat generated by drilling. The impact of osteocyte death and bone composition were assessed using molecular and cellular assays.

RESULTS

The phases of osteotomy healing in mice align closely with results in large animals; in addition, molecular analyses extended our understanding of osteoprogenitor cell proliferation, differentiation, and mineralization. Computational analyses provided insights into temperature changes caused by drilling and the mechanobiological state in the healing osteotomies, while concomitant cellular assays correlate drill speed with osteocyte apoptosis and bone resorption. Even when drilling was controlled, trabeculated, spongy (Type III) bone healed faster than densely lamellar (Type I) bone because of the abundance of Wnt responsive osteoprogenitor cells in the former.

CONCLUSIONS

These data provide a mechanobiological framework for evaluating tools and technologies designed to improve osteotomy site preparation.

Mimetization of the elastic properties of cancellous bone via a parameterized cellular material

Bone tissue mechanical properties and trabecular microarchitecture are the main factors that determine the biomechanical properties of cancellous bone. Artificial cancellous microstructures, typically described by a reduced number of geometrical parameters, can be designed to obtain a mechanical behavior mimicking that of natural bone. In this work, we assess the ability of the parameterized microstructure introduced by Kowalczyk (Comput Methods Biomech Biomed Eng 9:135-147, 2006. doi: 10.1080/10255840600751473 ) to mimic the elastic response of cancellous bone. Artificial microstructures are compared with actual bone samples in terms of elasticity matrices and their symmetry classes. The capability of the parameterized microstructure to combine the dominant isotropic, hexagonal, tetragonal and orthorhombic symmetry classes in the proportions present in the cancellous bone is shown. Based on this finding, two optimization approaches are devised to find the geometrical parameters of the artificial microstructure that better mimics the elastic response of a target natural bone specimen: a Sequential Quadratic Programming algorithm that minimizes the norm of the difference between the elasticity matrices, and a Pattern Search algorithm that minimizes the difference between the symmetry class decompositions. The pattern search approach is found to produce the best results. The performance of the method is demonstrated via analyses for 146 bone samples.

Advances in imaging approaches to fracture risk evaluation

Fragility fractures are a growing problem worldwide, and current methods for diagnosing osteoporosis do not always identify individuals who require treatment to prevent a fracture and may misidentify those not a risk. Traditionally, fracture risk is assessed using dual-energy X-ray absorptiometry, which provides measurements of areal bone mineral density at sites prone to fracture. Recent advances in imaging show promise in adding new information that could improve the prediction of fracture risk in the clinic. As reviewed herein, advances in quantitative computed tomography (QCT) predict hip and vertebral body strength; high-resolution HR-peripheral QCT (HR-pQCT) and micromagnetic resonance imaging assess the microarchitecture of trabecular bone; quantitative ultrasound measures the modulus or tissue stiffness of cortical bone; and quantitative ultrashort echo-time MRI methods quantify the concentrations of bound water and pore water in cortical bone, which reflect a variety of mechanical properties of bone. Each of these technologies provides unique characteristics of bone and may improve fracture risk diagnoses and reduce prevalence of fractures by helping to guide treatment decisions.

Effects of Condensation on Peri-implant Bone Density and Remodeling

Bone condensation is thought to densify interfacial bone and thus improve implant primary stability, but scant data substantiate either claim. We developed a murine oral implant model to test these hypotheses. Osteotomies were created in healed maxillary extraction sites 1) by drilling or 2) by drilling followed by stepwise condensation with tapered osteotomes. Condensation increased interfacial bone density, as measured by a significant change in bone volume/total volume and trabecular spacing, but it simultaneously damaged the bone. On postimplant day 1, the condensed bone interface exhibited microfractures and osteoclast activity. Finite element modeling, mechanical testing, and immunohistochemical analyses at multiple time points throughout the osseointegration period demonstrated that condensation caused very high interfacial strains, marginal bone resorption, and no improvement in implant stability. Collectively, these multiscale analyses demonstrate that condensation does not positively contribute to implant stability.

The effects of Labisia pumila extracts on bone microarchitecture of ovariectomized-induced osteoporosis rats: A micro-CT analysis

BACKGOUND

Labisia pumila (LP) is a popular herb used by women over the past few decades. This herb has shown potentials as an alternative agent for treatment and prevention of postmenopausal osteoporosis. It was observed in previous studies that supplementation to ovariectomized rats were associated with increased bone antioxidative enzymes and reduced lipid peroxidation activity. It had also improved bone formation markers in ovariectomized rats. This study aimed to evaluate the effects of giving different forms of LP extracts on the trabecular bone microarchitecture of ovariectomised rats.

METHODS

Forty-eight female Sprague-Dawley rats were randomly divided into sham-operated (Sham), ovariectomized control (OVX), ovariectomized and given estrogen at 64.5 μg/kg (ERT), ovariectomized and given LP aqueous extract (LPaq), LP methanol extract (LPmet) and LP ethanol extract (LPet) at 100 mg/kg, respectively. Treatments were given daily via oral gavages for nine weeks. Following sacrifice, femora were dissected out for bone microarchitectural analysis using an in vitro micro-CT, which provided three dimensional informations on bone microarchitecture.

RESULTS

LPaq was the most effective extract found to improve the bone microarchitectural paramaters which comprised ofBone volume fraction (BV/TV), Trabecular separation (Tb.Sp), Trabecular number (Tb.N), Connective density (Conn.dens), Structure model index (SMI) and Degree of anisotropy (DA).

CONCLUSION

LPaq was effective in protecting the bone of postmenopausal osteoporosis rat model against microarchitectural deterioration.

Changed Morphology and Mechanical Properties of Cancellous Bone in the Mandibular Condyles of Edentate People

Since edentate subjects have a reduced masticatory function, it can be expected that the morphology of the cancellous bone of their mandibular condyles has changed according to the altered mechanical environment. In the present study, the morphology of cylindrical cancellous bone specimens of the mandibular condyles of edentate subjects (n = 25) was compared with that of dentate subjects (n = 24) by means of micro-computed tomography and by the application of Archimedes’ principle. Stiffness and strength were determined by destructive mechanical testing. Compared with dentate subjects, it appeared that, in edentate subjects, the bone was less dense and the trabecular structure was less plate-like. The regression models of stiffness and strength built from bone volume fraction and the trabecular orientation relative to the axis of the specimen were similar for both dentate and edentate subjects. This indicates that, under reduced mechanical load, the fundamental relationship between bone morphology and mechanical properties does not change.

Six Weeks of Daily Abaloparatide Treatment Increased Vertebral and Femoral Bone Mineral Density, Microarchitecture and Strength in Ovariectomized Osteopenic Rats

Abaloparatide is a novel, potent and selective activator of parathyroid hormone receptor 1 (PTHR1) under clinical development for the treatment of osteoporosis. We assessed the effect of 6 weeks of abaloparatide on bone mass, microarchitecture, quality and strength in ovariectomized (OVX) rats. After 8 weeks of post-surgical bone depletion (baseline), OVX rats (n = 20-21/group) received daily subcutaneous vehicle (OVX-Veh) or abaloparatide at 5 or 20 µg/kg. Sham-operated control rats (n = 24) received vehicle. Areal bone mineral density (aBMD) of the lumbar spine (L4), total femur and femur diaphysis was measured at baseline and after 6 weeks of treatment. Femur and vertebral bone architecture and mechanical properties were assessed at the end of the treatment phase. At baseline, OVX-Veh rats exhibited significantly lower aBMD relative to Sham controls. Treatment of OVX rats with abaloparatide at 5 or 20 µg/kg/day increased aBMD dose-dependently in the lumbar spine, total femur and femur diaphysis to levels exceeding OVX-Veh or Sham controls. The abaloparatide 5 and 20 µg/kg groups had improved trabecular microarchitecture relative to OVX vehicle, with trabecular BV/TV exceeding OVX-Veh control values by 57 and 78 % (respectively) at the lumbar spine, and by 145 and 270 % at the distal femur. Femur diaphyseal cortical volume and thickness were significantly greater in the abaloparatide 20 µg/kg group relative to OVX vehicle or Sham controls. Bone strength parameters of the femur diaphysis, femur neck and L4 vertebra were significantly improved in the OVX-ABL groups relative to OVX-Veh controls. Bone mass-strength relationships and estimated intrinsic strength properties suggested maintained or improved bone quality with abaloparatide. These data demonstrate skeletal restoration via abaloparatide treatment of osteopenic OVX rats, in association with improved trabecular microarchitecture, cortical geometry and bone strength at sites that have clinical relevance in patients with osteoporosis.

Experimental and Numerical Models of Complex Clinical Scenarios; Strategies to Improve Relevance and Reproducibility of Joint Replacement Research

This research review aims to focus attention on the effect of specific surgical and host factors on implant fixation, and the importance of accounting for them in experimental and numerical models. These factors affect (a) eventual clinical applicability and (b) reproducibility of findings across research groups. Proper function and longevity for orthopedic joint replacement implants relies on secure fixation to the surrounding bone. Technology and surgical technique has improved over the last 50 years, and robust ingrowth and decades of implant survival is now routinely achieved for healthy patients and first-time (primary) implantation. Second-time (revision) implantation presents with bone loss with interfacial bone gaps in areas vital for secure mechanical fixation. Patients with medical comorbidities such as infection, smoking, congestive heart failure, kidney disease, and diabetes have a diminished healing response, poorer implant fixation, and greater revision risk. It is these more difficult clinical scenarios that require research to evaluate more advanced treatment approaches. Such treatments can include osteogenic or antimicrobial implant coatings, allo- or autogenous cellular or tissue-based approaches, local and systemic drug delivery, surgical approaches. Regarding implant-related approaches, most experimental and numerical models do not generally impose conditions that represent mechanical instability at the implant interface, or recalcitrant healing. Many treatments will work well in forgiving settings, but fail in complex human settings with disease, bone loss, or previous surgery. Ethical considerations mandate that we justify and limit the number of animals tested, which restricts experimental permutations of treatments. Numerical models provide flexibility to evaluate multiple parameters and combinations, but generally need to employ simplifying assumptions. The objectives of this paper are to (a) to highlight the importance of mechanical, material, and surgical features to influence implant-bone healing, using a selection of results from two decades of coordinated experimental and numerical work and (b) discuss limitations of such models and the implications for research reproducibility. Focusing model conditions toward the clinical scenario to be studied, and limiting conclusions to the conditions of a particular model can increase clinical relevance and research reproducibility.

Trabecular bone structural variation throughout the human lower limb

Trabecular bone is responsive to mechanical loading, and thus may be a useful tool for interpreting past behaviour from fossil morphology. However, the ability to meaningfully interpret variation in archaeological and hominin trabecular morphology depends on the extent to which trabecular bone properties are integrated throughout the postcranium or are locally variable in response to joint specific loading. We investigate both of these factors by comparing trabecular bone throughout the lower limb between a group of highly mobile foragers and two groups of sedentary agriculturalists. Trabecular bone structure is quantified in four volumes of interest placed within the proximal and distal joints of the femur and tibia. We determine how trabecular structures correspond to inferred behavioural differences between populations and whether the patterns are consistent throughout the limb. A significant correlation was found between inferred mobility level and trabecular bone structure in all volumes of interest along the lower limb. The greater terrestrial mobility of foragers is associated with higher bone volume fraction, and thicker and fewer trabeculae (lower connectivity density). In all populations, bone volume fraction decreases while anisotropy increases proximodistally throughout the lower limb. This observation mirrors reductions in cortical bone mass resulting from proximodistal limb tapering. The reduction in strength associated with reduced bone volume fraction may be compensated for by the increased anisotropy in the distal tibia. A similar pattern of trabecular structure is found throughout the lower limb in all populations, upon which a signal of terrestrial mobility appears to be superimposed. These results support the validity of using lower limb trabecular bone microstructure to reconstruct terrestrial mobility levels from the archaeological and fossil records. The results further indicate that care should be taken to appreciate variation resulting from differences in habitual activity when inferring behaviour from the trabecular structure of hominin fossils through comparisons with modern humans.

The relationship between dental implant stability and trabecular bone structure using cone-beam computed tomography

Purpose

The objective of this study was to investigate the relationships between primary implant stability as measured by impact response frequency and the structural parameters of trabecular bone using cone-beam computed tomography(CBCT), excluding the effect of cortical bone thickness.

Methods

We measured the impact response of a dental implant placed into swine bone specimens composed of only trabecular bone without the cortical bone layer using an inductive sensor. The peak frequency of the impact response spectrum was determined as an implant stability criterion (SPF). The 3D microstructural parameters were calculated from CT images of the bone specimens obtained using both micro-CT and CBCT.

Results

SPF had significant positive correlations with trabecular bone structural parameters (BV/TV, BV, BS, BSD, Tb.Th, Tb.N, FD, and BS/BV) (P<0.01) while SPF demonstrated significant negative correlations with other microstructural parameters (Tb.Sp, Tb.Pf, and SMI) using micro-CT and CBCT (P<0.01).

Conclusions

There was an increase in implant stability prediction by combining BV/TV and SMI in the stepwise forward regression analysis. Bone with high volume density and low surface density shows high implant stability. Well-connected thick bone with small marrow spaces also shows high implant stability. The combination of bone density and architectural parameters measured using CBCT can predict the implant stability more accurately than the density alone in clinical diagnoses.

Trabecular bone of precocials at birth; Are they prepared to run for the wolf(f)?

Bone is a dynamic tissue adapting to loading according to “Wolff's law of bone adaptation.” During very early life, however, such a mechanism may not be adequate enough to adapt to the dramatic change in environmental challenges in precocial species. Their neonates are required to stand and walk within hours after birth, in contrast to altricial animals that have much more time to adapt from the intrauterine environment to the outside world. In this study, trabecular bone parameters of the talus and sagittal ridge of the tibia from stillborn but full‐term precocials (calves and foals) were analyzed by micro‐CT imaging in order to identify possible anticipatory mechanisms to loading. Calculated average bone volume fraction in the Shetland pony (49–74%) was significantly higher compared to Warmblood foals (28–51%). Bovine trabecular bone was characterized by a low average bone volume fraction (22–28%), however, more directional anisotropy was found. It is concluded that anticipatory strategies in skeletal development exist in precocial species, which differ per species and are most likely related to anatomical differences in joint geometry and related loading patterns. The underlying regulatory mechanisms are still unknown, but they may be based on a genetic blueprint for the development of bone. More knowledge, both about a possible blueprint and its regulation, will be helpful in understanding developmental bone and joint diseases. J. Morphol. 277:948–956, 2016. © 2016 Wiley Periodicals, Inc.

Bone volume fraction and fabric anisotropy are better determinants of trabecular bone stiffness than other morphological variables

As our population ages, more individuals suffer from osteoporosis. This disease leads to impaired trabecular architecture and increased fracture risk. It is essential to understand how morphological and mechanical properties of the cancellous bone are related. Morphology-elasticity relationships based on bone volume fraction (BV/TV) and fabric anisotropy explain up to 98% of the variation in elastic properties. Yet, other morphological variables such as individual trabeculae segmentation (ITS) and trabecular bone score (TBS) could improve the stiffness predictions. A total of 743 micro-computed tomography (μCT) reconstructions of cubic trabecular bone samples extracted from femur, radius, vertebrae, and iliac crest were analyzed. Their morphology was assessed via 25 variables and their stiffness tensor (CFE) was computed from six independent load cases using micro finite element (μFE) analyses. Variance inflation factors were calculated to evaluate collinearity between morphological variables and decide upon their inclusion in morphology-elasticity relationships. The statistically admissible morphological variables were included in a multiple linear regression model of the dependent variable CFE. The contribution of each independent variable was evaluated (ANOVA). Our results show that BV/TV is the best determinant of CFE(r(2) adj  = 0.889), especially in combination with fabric anisotropy (r(2) adj  = 0.968). Including the other independent predictors hardly affected the amount of variance explained by the model (r(2) adj  = 0.975). Across all anatomical sites, BV/TV explained 87% of the variance of the bone elastic properties. Fabric anisotropy further described 10% of the bone stiffness, but the improvement in variance explanation by adding other independent factors was marginal (<1%). These findings confirm that BV/TV and fabric anisotropy are the best determinants of trabecular bone stiffness and show, against common belief, that other morphological variables do not bring any further contribution. These overall conclusions remain to be confirmed for specific bone diseases and postelastic properties.

A mesoscale study of the degradation of bone structural properties in modeled microgravity conditions

One of the most important alterations that occur in man and experimental animals during spaceflight concerns the skeletal system, and entails important bone loss and degradation of mechanical properties. In the present work we investigate ex vivo the long-term effects of weightlessness (simulated microgravity) on bone tissue, by comparing the mesoscale structural properties of weight-bearing rat tibial epiphyseal cancellous structures of healthy animals (ground controls) with those of identical bone explants maintained ex vivo in the Rotary Cell Culture System (RCCS) bioreactor, used to model, on ground, microgravity conditions. Bone structures were reconstructed by synchrotron radiation micro-CT, morphometric analyses were performed, and the apparent elastic properties were computed by means of a numerical model based on the Cell Method. Two novel results were achieved in this study. First of all, the skeletal modifications found in bone explants after 3-4 weeks of culture in the RCCS bioreactor are in perfect agreement with those observed in vivo after a long-term spaceflight (Mice Drawer System mission, 2009), thus confirming the relevance of our model in reproducing the effects of microgravity on whole bone tissue. Secondly, but not less importantly, our study points out that the degradation in bone structural performance (apparent mechanical properties) must be considered in order to achieve an accurate representation of trabecular bone modifications not only in osteoporotic bone diseases, but also in the microgravity-induced bone alterations. In conclusion, our findings, by proving that the association of the RCCS bioreactor-based culture method, used to model microgravity conditions, with numerical simulations able to quantify bone quality, represents the first ground-based reliable model for investigating, ex vivo, some of the spaceflight effects on bone tissue, and open new perspectives to basic research and clinical applications.

Biomechanics and mechanobiology of trabecular bone: a review

Trabecular bone is a highly porous, heterogeneous, and anisotropic material which can be found at the epiphyses of long bones and in the vertebral bodies. Studying the mechanical properties of trabecular bone is important, since trabecular bone is the main load bearing bone in vertebral bodies and also transfers the load from joints to the compact bone of the cortex of long bones. This review article highlights the high dependency of the mechanical properties of trabecular bone on species, age, anatomic site, loading direction, and size of the sample under consideration. In recent years, high resolution micro finite element methods have been extensively used to specifically address the mechanical properties of the trabecular bone and provide unique tools to interpret and model the mechanical testing experiments. The aims of the current work are to first review the mechanobiology of trabecular bone and then present classical and new approaches for modeling and analyzing the trabecular bone microstructure and macrostructure and corresponding mechanical properties such as elastic properties and strength.

Directional Tortuosity as a Predictor of Modulus Damage for Vertebral Cancellous Bone

There are many methods used to estimate the undamaged effective (apparent) moduli of cancellous bone as a function of bone volume fraction (BV/TV), mean intercept length (MIL), and other image based average microstructural measures. The MIL and BV/TV are both only functions of the cancellous microstructure and, therefore, cannot directly account for damage induced changes in the intrinsic trabecular hard tissue mechanical properties. Using a nonlinear finite element (FE) approximation for the degradation of effective modulus as a function of applied effective compressive strain, we demonstrate that a measurement of the directional tortuosity of undamaged trabecular hard tissue strongly predicts directional effective modulus (r2 > 0.90) and directional effective modulus degradation (r2 > 0.65). This novel measure of cancellous bone directional tortuosity has the potential for development into an anisotropic approach for calculating effective mechanical properties as a function of trabecular level material damage applicable to understanding how tissue microstructure and intrinsic hard tissue moduli interact to determine cancellous bone quality.

Does mechanical stimulation really protect the architecture of trabecular bone? A simulation study

Although it is beyond doubt that mechanical stimulation is crucial to maintain bone mass, its role in preserving bone architecture is much less clear. Commonly, it is assumed that mechanics helps to conserve the trabecular network since an "accidental" thinning of a trabecula due to a resorption event would result in a local increase of load, thereby activating bone deposition there. However, considering that the thin trabecula is part of a network, it is not evident that load concentration happens locally on the weakened trabecula. The aim of this work was to clarify whether mechanical load has a protective role for preserving the trabecular network during remodeling. Trabecular bone is made dynamic by a remodeling algorithm, which results in a thickening/thinning of trabeculae with high/low strain energy density. Our simulations show that larger deviations from a regular cubic lattice result in a greater loss of trabeculae. Around lost trabeculae, the remaining trabeculae are on average thinner. More generally, thin trabeculae are more likely to have thin trabeculae in their neighborhood. The plausible consideration that a thin trabecula concentrates a higher amount of strain energy within itself is therefore only true when considering a single isolated trabecula. Mechano-regulated remodeling within a network-like architecture leads to local concentrations of thin trabeculae.

Enhanced individual trabecular repair and its mechanical implications in parathyroid hormone and alendronate treated rat tibial bone

Combined parathyroid hormone (PTH) and bisphosphonate (alendronate-ALN) therapy has recently been shown to increase bone volume fraction and plate-like trabecular structure beyond either monotherapy. To identify the mechanism through which plate-like structure was enhanced, we used in vivo microcomputed tomography (μCT) of the proximal tibia metaphysis and individual trabecular dynamics (ITD) analysis to quantify connectivity repair (incidences of rod connection and plate perforation filling) and deterioration (incidences of rod disconnection and plate perforation). Three-month-old female, intact rats were scanned before and after a 12 day treatment period of vehicle (Veh, n = 5), ALN (n = 6), PTH (n = 6), and combined (PTH+ALN, n = 6) therapy. Additionally, we used computational simulation and finite element (FE) analysis to delineate the contributions of connectivity repair or trabecular thickening to trabecular bone stiffness. Our results showed that the combined therapy group had greater connectivity repair (5.8 ± 0.5% connected rods and 2.0 ± 0.3% filled plates) beyond that of the Veh group, resulting in the greatest net gain in connectivity. For all treatment groups, increases in bone volume due to thickening (5-31%) were far greater than those due to connectivity repair (2-3%). Newly formed bone contributing only to trabecular thickening caused a 10%, 41%, and 69% increase in stiffness in the ALN, PTH, and PTH+ALN groups, respectively. Moreover, newly formed bone that led to connectivity repair resulted in an additional improvement in stiffness, with the highest in PTH+ALN (by an additional 12%), which was significantly greater than either PTH (5.6%) or ALN (4.5%). An efficiency ratio was calculated as the mean percent increase in stiffness divided by mean percent increase in BV for either thickening or connectivity repair in each treatment. For all treatments, the efficiency ratio of connectivity repair (ALN: 2.9; PTH: 3.4; PTH+ALN: 4.4) was higher than that due to thickening (ALN: 2.0; PTH: 1.7; PTH+ALN: 2.2), suggesting connectivity repair required less new bone formation to induce larger gains in stiffness. We conclude that through rod connection and plate perforation filling PTH+ALN combination therapy improved bone stiffness in a more efficient and effective manner than either monotherapy.

Trabecular evidence for a human-like gait in Australopithecus africanus

Although the earliest known hominins were apparently upright bipeds, there has been mixed evidence whether particular species of hominins including those in the genus Australopithecus walked with relatively extended hips, knees and ankles like modern humans, or with more flexed lower limb joints like apes when bipedal. Here we demonstrate in chimpanzees and humans a highly predictable and sensitive relationship between the orientation of the ankle joint during loading and the principal orientation of trabecular bone struts in the distal tibia that function to withstand compressive forces within the joint. Analyses of the orientation of these struts using microCT scans in a sample of fossil tibiae from the site of Sterkfontein, of which two are assigned to Australopithecus africanus, indicate that these hominins primarily loaded their ankles in a relatively extended posture like modern humans and unlike chimpanzees. In other respects, however, trabecular properties in Au africanus are distinctive, with values that mostly fall between those of chimpanzees and humans. These results indicate that Au. africanus, like Homo, walked with an efficient, extended lower limb.

Of mice, rats and men: trabecular bone architecture in mammals scales to body mass with negative allometry

Body mass (BM) in mammal species spans over six orders of magnitude. Although trabecular bone contributes to the mechanical properties of bones, we know much less about how trabecular bone scales with BM than about how cortical bone scales with BM. We therefore conducted a meta-analysis of the existing literature to test in rodents, humans and other mammals, predicted scaling properties between BM and several trabecular parameters: bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), connectivity density (ConnD) and degree of anisotropy (DA). Our results show that BV/TV and DA are independent of BM and that Tb.N, Tb.Th and Tb.Sp scale with negative allometry relative to BM. Rodents appear to have relatively thicker and fewer trabeculae than humans, and we propose it that is due to a minimum thickness threshold "imposed" on mechanically functional trabeculae. Consequently, rodents (mice and rats) and humans demonstrate two distinct mechanisms to achieve variations in BV/TV. Although Tb.Th variation is the main contributing factor for differences in BV/TV in humans, Tb.N variation is the main contributing factor for differences in BV/TV in rodents. Our results also demonstrate no correlation between Tb.N and Tb.Th within each taxon (mice, rats and humans). Since rodents are a common animal model for research on bone biomechanics, the evidence that trabecular bone parameters scale and correlate differently in rodents than in humans suggests that care should be applied when extrapolating bone biomechanical results from small animals to large-bodied humans.

Stochastic multi-scale prediction on the apparent elastic moduli of trabecular bone considering uncertainties of biological apatite (BAp) crystallite orientation and image-based modelling

An assessment of the mechanical properties of trabecular bone is important in determining the fracture risk of human bones. Many uncertainty factors contribute to the dispersion of the estimated mechanical properties of trabecular bone. This study was undertaken in order to propose a computational scheme that will be able to predict the effective apparent elastic moduli of trabecular bone considering the uncertainties that are primarily caused by image-based modelling and trabecular stiffness orientation. The effect of image-based modelling which focused on the connectivity was also investigated. A stochastic multi-scale method using a first-order perturbation-based and asymptotic homogenisation theory was applied to formulate the stochastically apparent elastic properties of trabecular bone. The effective apparent elastic modulus was predicted with the introduction of a coefficient factor to represent the variation of bone characteristics due to inter-individual differences. The mean value of the predicted effective apparent Young's modulus in principal axis was found at approximately 460 MPa for respective 15.24% of bone volume fraction, and this is in good agreement with other experimental results. The proposed method may provide a reference for the reliable evaluation of the prediction of the apparent elastic properties of trabecular bone.

THE EFFECT OF THRESHOLD VALUE ON THE ARCHITECTURAL PARAMETERS AND STIFFNESS OF HUMAN CANCELLOUS BONE IN MICRO CT ANALYSIS

In this study, the effects of threshold variation in image segmentation of micro CT images of cancellous bone in the determination of the architectural parameters and stiffness were investigated. A total of 42 samples of 6 × 6 × 6 mm3 cubes with threshold values set between 500–1100 greyscale in increment of 100 of CT images of six human C5 vertebral bodies were analyzed. Threshold value of 800, based on Otsu's method, was set for the control group. From various threshold values, the respective architectural parameters, and the corresponding stiffness in three orthotropic directions (Exx, Eyy, Ezz) of each cube were computed from the voxel-based micro-finite element models under compressive simulation. The results showed that 1% variation of threshold value resulted in a 3.4% variation in BV/TV, 2% in Tb.N, 3.1% in Tb.Th, 2.9% in BS/BV, 1.8% in Tb.Sp, 29.2% in Exx, 28.7% Eyy and 27.7% in Ezz. Statistical analysis showed that 2.9% threshold variation caused significant change in BV/TV, Tb.Th, Exx, Eyy and Ezz values. The study shows that with threshold variation of more than 2.9%, significant differences in the architectural parameters and stiffness compared to those based on Otsu's method.

Load transfer through the radiocarpal joint and the effects of partial wrist arthrodesis on carpal bone behaviour: a finite element study

A finite element model of the wrist was developed to simulate mechanical changes that occur after surgery of the wrist. After partial arthrodesis, the wrist will experience altered force transmission during loading. Three different types of partial arthrodesis were investigated - radiolunate, radioscaphoid, and radioscapholunate - and compared with the healthy untreated wrist. The results showed that the compressive forces on the radiocarpal joint decreased compared with the untreated wrist with both radiolunate and radioscaphoid fusions. The load transmission through the midcarpal joints varied depending on arthrodesis type. The forces in the extrinsic ligaments decreased with the fusion, most noticeably in the dorsal radiotriquetral ligament, but increased in the dorsal scaphotriquetral ligament. From the results of the study it can be concluded that the radioscapholunate fusion shows the most biomechanically similar behaviour out of the three fusion types compared with the healthy wrist. The modelling described in this paper may be a useful approach to pre-operative planning in wrist surgery.

A new method for analyzing local shape in three-dimensional images based on medial axis transformation

In this paper, we propose a new approach based on three-dimensional (3-D) medial axis transformation for describing geometrical shapes in three-dimensional images. For 3-D-images, the medial axis, which is composed of both curves and medial surfaces, provides a simplified and reversible representation of structures. The purpose of this new method is to classify each voxel of the three-dimensional images in four classes: boundary, branching, regular and arc points. The classification is first performed on the voxels of the medial axis. It relies on the topological properties of a local region of interest around each voxel. The size of this region of interest is chosen as a function of the local thickness of the structure. Then, the reversibility of the medial axis is used to deduce a labeling of the whole object. The proposed method is evaluated on simulated images. Finally, we present an application of the method to the identification of bone structures from 3-D very high-resolution tomographic images.

Investigation of the influence of reflection on the attenuation of cancellous bone

The model proposed in this paper is based on the fact that the reflection might have a significant contribution to the attenuation of the acoustic waves propagating through the cancellous bone. The numerical implementation of the mentioned effect is realized by the development of a new representative volume element that includes an infinitesimally thin 'transient' layer on the contact surface of the bone and the marrow. This layer serves to model the amplitude transformation of the incident wave by the transition through media with different acoustic impedances and to take into account the energy loss due to the reflection. The proposed representative volume element together with the multiscale finite element is used to simulate the wave propagation and to evaluate the attenuation coefficient for samples with different effective densities in the dependence of the applied excitation frequency. The obtained numerical values show a very good agreement with the experimental results. Moreover, the model enables the determination of the upper and the lower bound for the attenuation coefficient.

Three-dimensional evaluation of mandibular bone regenerated by bone transport distraction osteogenesis

The purpose of this study was to evaluate the structure and material properties of native mandibular bone and those of early regenerate bone, produced by bone transport distraction osteogenesis. Ten adult foxhounds were divided into two groups of five animals each. In all animals, a 3- to 4-cm defect was created on one side of the mandible. A bone transport reconstruction plate, consisting of a reconstruction plate with an attached intraoral transport unit, was utilized to stabilize the mandible and regenerate bone at a rate of 1 mm/day. After the distraction period was finished, the animals were killed at 6 and 12 weeks of consolidation. Micro-computed tomography was used to assess the morphometric and structural indices of regenerate bone and matching bone from the unoperated contralateral side. Significant new bone was formed within the defect in the 6- and 12-week groups. Significant differences (P ≤ 0.05) between mandibular regenerated and native bone were found in regard to bone volume fraction, mineral density, bone surface ratio, trabecular thickness, trabecular separation, and connectivity density, which increased from 12 to 18 weeks of consolidation. We showed that regenerated bone is still mineralizing and that native bone appears denser because of a thick outer layer of cortical bone that is not yet formed in the regenerate. However, the regenerate showed a significantly higher number of thicker trabeculae.