Structure model index does not measure rods and plates in trabecular bone

Structure model index (SMI) is widely used to measure rods and plates in trabecular bone. It exploits the change in surface curvature that occurs as a structure varies from spherical (SMI = 4), to cylindrical (SMI = 3) to planar (SMI = 0). The most important assumption underlying SMI is that the entire bone surface is convex and that the curvature differential is positive at all points on the surface. The intricate connections within the trabecular continuum suggest that a high proportion of the surface could be concave, violating the assumption of convexity and producing regions of negative differential. We implemented SMI in the BoneJ plugin and included the ability to measure the amounts of surface that increased or decreased in area after surface mesh dilation, and the ability to visualize concave and convex regions. We measured SMI and its positive (SMI+) and negative (SMI-) components, bone volume fraction (BV/TV), the fraction of the surface that is concave (CF), and mean ellipsoid factor (EF) in trabecular bone using 38 X-ray microtomography (XMT) images from a rat ovariectomy model of sex steroid rescue of bone loss, and 169 XMT images from a broad selection of 87 species' femora (mammals, birds, and a crocodile). We simulated bone resorption by eroding an image of elephant trabeculae and recording SMI and BV/TV at each erosion step. Up to 70%, and rarely less than 20%, of the trabecular surface is concave (CF 0.155 – 0.700). SMI is unavoidably influenced by aberrations from SMI-, which is strongly correlated with BV/TV and CF. The plate-to-rod transition in bone loss is an erroneous observation resulting from SMI's close and artefactual relationship with BV/TV. SMI cannot discern between the distinctive trabecular geometries typical of mammalian and avian bone, whereas EF clearly detects birds' more plate-like trabeculae. EF is free from confounding relationships with BV/TV and CF. SMI results reported in the literature should be treated with suspicion. We propose that EF should be used instead of SMI for measurements of rods and plates in trabecular bone

3D micro-computed tomography of trabecular and cortical bone architecture with application to a rat model of immobilisation osteoporosis

Bone mass and microarchitecture are the main determinants of bone strength. Three-dimensional micro-computed tomogrpahy has the potential to examine complete bones of small laboratory animals with very high resolution in a non-invasive way. In the presented work, the proximal part of the tibiae of hindlimb unloaded and control rats were measured with 3D MicroCT, and the secondary spongiosa of the scanned region was evaluated using direct evaluation techniques that do not require model assumptions. For determination of the complete bone status, the cortex of the tibiae was evaluated and characterised by its thickness. It is shown that with the proposed anatomically conforming volume of interest (VOI), up to an eight-fold volume increase can be evaluated compared to cubic or spherical VOIs. A pronounced trabecular bone loss of −50% is seen after 23 days of tail suspension. With the new evaluation techniques, it is shown that most of this bone loss is caused by the thinning of trabeculae, and to a lesser extent by a decrease in their number. What changes most radically is the structure type: the remaining bone is more rod-like than the control group's bone. Cortical bone decreases less than trabecular bone, with only −18% after 23 day

Long-term prediction of three-dimensional bone architecture in simulations of pre-, peri- and post-menopausal microstructural bone remodeling

The mechanical behavior of trabecular bone depends on the internal bone structure. It is generally accepted now that the trabecular bone structure is a result of a load adaptive bone remodeling. The mathematical laws that relate bone remodeling to the local state of stress and strain, however, are still under investigation. The aim of this project was to investigate if changes in the trabecular architecture as observed with age-related bone loss and osteoporosis can be predicted from a computer model that simulates bone resorption after hormone depletion based on realistic models of trabecular microstructure using micro-computed tomography (μCT). A compact desktop μCT providing a nominal isotropic resolution of 14μm was used to measure two groups of seven trabecular bone specimens from pre-menopausal and post-menopausal women respectively. A novel algorithm was developed to simulate age-related bone loss for the specimens in the first group. The algorithm, also referred to as simulated bone atrophy (SIBA), describes a truly three-dimensional approach and is based directly on cellular bone remodeling with an underlying realistic time frame. Bone resorption is controlled by osteoclastic penetration depth and bone formation is governed by the efficiency level of the osteoblasts. The simulation itself describes an iterative process with a cellular remodeling cycle of 197 days. Activation frequency is controllable and can be adjusted for the different phases of pre-, peri- and post-menopause. For our simulations, osteoblastic and osteoclastic activities were in balance until the onset of menopause, set to be at the age of 50 years. In that period, the structure remained almost constant. After the onset of menopause an imbalance in the cell activities was modeled resulting in a net bone loss. The doubling of the activation frequency in the peri-menopausal phase caused a pronounced loss. Using advanced animation tools and quantitative bone morphometry, the changes in bone architecture associated with the bone loss were monitored over an average observation time of 43 years until the age of 80 years. In that time, bone volume density decreased monotonously with the progression of the simulation for all specimens. Right after the onset of menopause, bone was lost fast, where with the progression of age losses slowed down. The structures at the end-point of the simulations were then compared qualitatively and quantitatively to the structures of the post-menopausal group with all morphometric indices being within a narrow margin of error. These results suggest the feasibility of transforming "normal” to "osteopenic” bone on a microstructural level yielding in realistic bone models similar in appearance as well as in structural behavior if compared to a post-menopausal group of wome

Bone microarchitecture in human foetuses

articleBone microarchitecture is receiving increasing attention in theassessment of the biomechanical properties of bone. While it iswell characterized in normal and pathologic human subjects,few quantitative data are available in human fetal development.In this paper, quantitative parameters of bone microarchitecturein developing human bone are reviewed from the literature andsupplemented by new data from the femoral metaphysis of hu-man fetuses. The samples were imaged using synchrotron radi-ation 3D micro-CT and processed using customized analysismethods. This technique provides 3D model independent mor-phometric parameters, anisotropy, connectivity and geometrycharacteristics, as well as information on mineralization.The morphometric parameters obtained on fetal vertebrae andfemurs evidenced a dense trabecular structure as comparedto that of young adults. The histomorphometric and the 3D mi-cro-CT analysis were consistent to show a significant in-crease of trabecular bone volume with gestational age. Tra-becular bone was found isotropic in vertebral bodies andanisotropic in femoral metaphysis, demonstrating a radialgrowth in vertebrae, and a longitudinal spreading out in longbones such as the femurs. Trabecular thickness in the maturebone of vertebral body and femoral metaphysis was around100 μm, which was in agreement with histomorphometric eval-uation. In the femoral metaphysis, three-dimensional analysisconfirmed the thickening of trabeculae with the distance tothe growth plate, and an estimated rate of thickening around 3μm/day previously obtained in histomorphometry. The 3D net-work was highly connected, and our new geometrical analysistechnique showed a strong prevalence of rod structure ascompared to the plate structure in cancellous bone

Imaging techniques for the assessment of the bone osteoporosis-induced variations with particular focus on micro-ct potential

For long time, osteoporosis (OP) was exclusively associated with an overall bone mass reduction, leading to lower bone strength and to a higher fracture risk. For this reason, the measurement of bone mineral density through dual X-ray absorptiometry was considered the gold standard method for its diagnosis. However, recent findings suggest that OP causes a more complex set of bone alterations, involving both its microstructure and composition. This review aims to provide an overview of the most evident osteoporosis-induced alterations of bone quality and a résumé of the most common imaging techniques used for their assessment, at both the clinical and the laboratory scale. A particular focus is dedicated to the micro-computed tomography (micro-CT) due to its superior image resolution, allowing the execution of more accurate morphometric analyses, better highlighting the architectural alterations of the osteoporotic bone. In addition, micro-CT has the potential to perform densitometric measurements and finite element method analyses at the microscale, representing potential tools for OP diagnosis and for fracture risk prediction. Unfortunately, technological improvements are still necessary to reduce the radiation dose and the scanning duration, parameters that currently limit the application of micro-CT in clinics for OP diagnosis, despite its revolutionary potential

Contributions of anisotropic and heterogeneous tissue modulus to apparent trabecular bone mechanical properties

The highly optimized hierarchical structure of trabecular bone is a major contributor to its remarkable mechanical properties. At the micro-scale level, individual plate-like and rod-like trabeculae are interconnected, forming a complex trabecular architecture. It is widely believed that bone strength, an important mechanical characteristic that describes the capability of bone to resist fracture, is largely determined by the tissue-level material properties of these microscopic trabecular elements. However, due to the complicated microstructure and irregular morphology of trabecular bone, a link between the tissue-level and the apparent level mechanics in trabecular bone has never been established. Thus, the goal of this thesis is to examine the tissue-level material properties of trabecular bone and their contribution to apparent-level bone mechanics, and ultimately to improve our fundamental understanding and assessment of bone strength in diseased and healthy patients. At the micro-scale level, plate-like and rod-like trabeculae are distinctly aligned along different orientations on the anatomical axis of the skeleton. Also, the highly organized underlying ultrastructure of bone tissue suggests trabecular bone might possess an anisotropic tissue modulus, i.e. different modulus in the axial and lateral cross-section of a trabecula. In this thesis, we studied this tissue-level anisotropy by examining mechanical properties of individual trabecular plates and rods aligned longitudinally, obliquely, and transversely on the anatomical axis using micro-indentation. We discovered that, despite the different orientations of trabeculae, tissue moduli are higher in the axial direction than in the lateral direction for both plates and rods. We also discovered that plates have a higher tissue modulus than rods, suggesting different degrees of mineralization. Furthermore, the tissue mineral density correlated strongly but distinctly with tissue modulus in the axial and lateral directions, providing descriptions on how spatially heterogeneous mineralization at the tissue level affects the tissue modulus. After characterization of the anisotropic and heterogeneous modulus of trabecular bone at the tissue level, we then sought to investigate its contribution to apparent-level mechanical properties, including apparent Young’s modulus and yield strength. Non-linear FE voxel models incorporating experimentally determined anisotropy and heterogeneity were created from micro-computed tomography (µCT) images of healthy trabecular bone samples. Apparent Young's modulus and yield strength predicted by the models were compared to and correlated with gold standard mechanical testing measurements, as well as to the same FE models without incorporation of anisotropy and/or heterogeneity. We discovered that the anisotropic model prediction was highly correlated and indistinguishable from mechanical testing measurements. However, the prediction power of the model was not enhanced by incorporating anisotropy and heterogeneity (compared to a homogeneous and isotropic model), suggesting that variances in tissue-level material properties contribute minimally to the apparent level bone behaviors in healthy bone. However, the possibility remained that a more substantial contribution could arise in diseased bone, particularly diseases in which tissue-level properties are compromised. Therefore, we studied trabecular bone in two diseased conditions – subchondral bone in human knees affected by osteoarthritis and pelvic bone affected by adolescent idiopathic sclerosis – to see how disease can alter the tissue-level and, consequently, apparent-level bone mechanics. In OA bone, we found a significant decrease in tissue modulus in the subchondral bone under severely damaged cartilage compared to control, which provides an explanation for a minimal increase in apparent stiffness with an almost doubled bone volume fraction. In AIS bone, no differences were found in tissue-level or apparent level Young’s modulus compared to control. However, the mineral density was found to play a distinct role in the modulus of growing bone tissue compared to mature bone

Characterising variability and regional correlations of microstructure and mechanical competence of human tibial trabecular bone: An in-vivo HR-pQCT study.

OBJECTIVE: Quantifying spatial distribution of trabecular bone mechanical competence and microstructure is important for early diagnosis of skeletal disorders and potential risk of fracture. The objective of this study was to determine a spatial distribution of trabecular mechanical and morphological properties in human distal tibia and examine the contribution of regional variability of trabecular microarchitecture to mechanical competence. METHODS: A total of 340 representative volume elements at five anatomic regions of trabecular bone - anterior, posterior, lateral, medial and centre - from ten white European-origin postmenopausal women were studied. Region-specific trabecular parameters such as trabecular volume fraction, trabecular thickness, trabecular number, trabecular surface area, trabecular separation, plate-like structure fraction and finite element analysis of trabecular stiffness were determined based on in-vivo high resolution peripheral quantitative computed tomographic (HR-pQCT) images of distal tibiae from ten postmenopausal women. Mean values were compared using analysis of variance. The correlations between morphological parameters and stiffness were calculated. RESULTS: Significant regional variation in trabecular microarchitecture of the human distal tibia was observed (0.001 ≤ p ≤ 0.05), with up to 106% differences between lowest (central and anterior) and highest (medial and posterior) regions. Higher proportion of plate-like trabecular morphology (63% and 53%) was found in medial and posterior regions in the distal tibia. Stiffness estimated from finite element models also differed significantly (0.001 ≤ p ≤ 0.05), with stiffness being 4.5 times higher in the highest (medial) than lowest (central) regions. The bone volume fraction was the strongest correlate of stiffness in all regions. CONCLUSION: A novel finding of this study is the fact that significant regional variation of stiffness derived from two-phased FEA model with individual trabecula representation correlated highly to regional morphology obtained from in-vivo HR-pQCT images at the distal tibia. The correlations between regional morphological parameters and mechanical competence of trabecular bone were consistent at all regions studied, with regional BV/TV showing the highest correlation. The method developed for regional analysis of trabecular mechanical competence may offer a better insight into the relationship between mechanical behaviour and microstructure of bone. The findings provide evidence needed to further justify a larger-cohort feasibility study for early detection of bone degenerative diseases: examining regional variations in mechanical competence and trabecular specifications may allow better understanding of fracture risks in addition to others contributing factors

Trabecular Reorganization in Consecutive Iliac Crest Biopsies when Switching from Bisphosphonate to Strontium Ranelate Treatment

BACKGROUND: Several agents are available to treat osteoporosis while addressing patient-specific medical needs. Individuals' residual risk to severe fracture may require changes in treatment strategy. Data at osseous cellular and microstructural levels due to a therapy switch between agents with different modes of action are rare. Our study on a series of five consecutively taken bone biopsies from an osteoporotic individual over a six-year period analyzes changes in cellular characteristics, bone microstructure and mineralization caused by a therapy switch from an antiresorptive (bisphosphonate) to a dual action bone agent (strontium ranelate). METHODOLOGY/PRINCIPAL FINDINGS: Biopsies were progressively taken from the iliac crest of a female patient. Four biopsies were taken during bisphosphonate therapy and one biopsy was taken after one year of strontium ranelate (SR) treatment. Furthermore, serum bone markers and dual x-ray absorptiometry measurements were acquired. Undecalcified histology was used to assess osteoid parameters and bone turnover. Structural indices and degree of mineralization were determined using microcomputed tomography, quantitative backscattered electron imaging, and combined energy dispersive x-ray/µ-x-ray-fluorescence microanalysis. CONCLUSIONS/SIGNIFICANCE: Microstructural data revealed a notable increase in bone volume fraction after one year of SR treatment compared to the bisphosphonate treatment period. Indices of connectivity density, structure model index and trabecular bone pattern factor were predominantly enhanced indicating that the architectural transformation from trabecular rods to plates was responsible for the bone volume increase and less due to changes in trabecular thickness and number. Administration of SR following bisphosphonates led to a maintained mineralization profile with an uptake of strontium on the bone surface level. Reactivated osteoclasts designed tunneling, hook-like intratrabecular resorption sites. The appearance of tunneling resorption lacunae and the formation of both mini-modeling units and osteon-like structures within increased plate-like cancellous bone mass provides additional information on the mechanisms of strontium ranelate following bisphosphonate treatment, which may deserve special attention when monitoring a treatment switch

Multiscale Quantitative Imaging of Human Femoral Heads Using X-ray Microtomography

PhDClinical diagnostic tools provide limited information on the underlying structural and mechanical properties of bone-tissue affected by degenerative and bone metabolic diseases. In-vivo bone failure studies provide limited information due to constraints such as X-ray dosage, cost and various other practicalities. In-vitro studies are thus required to enhance understanding of this phenomenon. The aims of this study were to use quantitative high-definition X-ray Micro-Tomography (XMT) to assess factors contributing to pathological and non-pathological bone failure and repair in relation to the mechanics of whole human femoral heads. XMT images of one normal and six pathological femoral heads were collected at 26 – 8.8 μm voxel resolution and evaluated to determine structural features; bone mineral concentration (BMC); and using image analysis, identify microcallus formations. In addition, in-vitro compression tests were carried out on specimens taken from regions with different anatomical loading. Bone quality was then related to the anatomical loading and BMC. Results from non-pathological tissue where used to establish a baseline for measurements of structural features. Microcallus formations where identified and used as markers to map the occurrence of bone damage. In osteoarthritic (OA) heads, the damage was found to be concentrated in localised clusters. Conversely, in the osteoporotic head damage was distributed homogeneously throughout the entire specimen. No significant difference in the BMC was observed, however there was a iii significant difference in the bone quality values between the non-pathological and pathological heads, and also between the pathologies. In-vitro mechanical testing revealed a difference in the mechanical properties of OA trabecular bone in relation to bone quality measurements but the samples exhibited no significant correlation to anatomical loading. X-ray Ultra Microscopy (XuM) at 200nm and 775nm voxel resolution was used to investigate the nano-morphology of individual trabeculae. The XuM images showed differences in bone structure and fewer osteocyte lacunae present close to fracture site. XuM also identified micro-cracks within trabeculae that were encased by microcallus formations. The application of novel quantitative high definition X-ray imaging to clinically relevant tissue at multiple length scales has provided new metrological data on the distribution of damage within pathological tissue. Insight into the vulnerability of diseased tissue to damage could ultimately lead to improved diagnosis from clinical radiographs