Prevention of osteoporotic bone fractures requires accurate diagnostic methods to detect the increase in bone fragility at an early stage of osteoporosis. However, today's bone fracture risk prediction, primarily based on bone density measurement, is not sufficiently precise. There is increasing evidence that, in addition to bone density, also the bone microarchitecture and its mechanical loading conditions are important factors determining the fracture risk. Recently, it has been shown that new high-resolution imaging techniques in combination with new computer modeling techniques based on the finite-element (FE) method can account for these additional factors. These techniques might provide information that is more relevant for the prediction of bone fracture risk. So far, however, these new imaged-based FE techniques have not been feasible in-vivo. The objectives of this study were to quantify the load transfer through the trabecular network in a distal radius using a computer model based on in-vivo high-resolution images and to determine if common regions of fractures can be explained as a result of high tissue loading in these regions. The left distal radius and the two adjacent carpal bones of a healthy volunteer were imaged using a high-resolution three-dimensional CT system providing an isotropic resolution of 165 μm. The bone representation was converted into a FE-model that was used to calculate stresses and strains in the trabecular network. The two carpal bones were loaded using different load ratios (for each load case 1000 N in total) representing impact forces on the hand either in near-neutral position or ulnar/radial deviation. The load transfer through the trabecular network of the radius was characterized by the tissue strain energy density (SED) distribution for all load cases. It was found that the distribution of the tissue loading depends on the ratio of the forces acting on the carpal bones. For all load cases the higher SED values (on average: 0.02±0.08 (S.D.) N mm−2) are found in a 10 mm region adjacent to the articular surface which corresponds well with the region where Colles- or Chauffeur-fractures occur. We expect that, eventually, this new approach can lead to a better prediction of the fracture risk than methods based on bone density alone since it accounts for the bone microstructure as well as its loading conditions.
Keywords: Osteoporosis; Computed tomography; Finite-element analysis; Bone fracture risk; Bone architecture