Bone mineral density (BMD) is often used for injury prediction and fracture risk evaluation. This study aims to determine the breadth and depth of BMD utilization in injury biomechanics research and evaluate the appropriateness of these approaches by assessing BMD sensitivity and variability throughout the human body. A scoping review was conducted examining post-mortem human subject (PMHS) experimental studies that utilized dual-energy x-ray absorptiometry (DXA) and/or quantitative computed tomography (QCT) for bone quality assessment. Subsequently, areal BMD (aBMD) and volumetric BMD (vBMD) of 76 male PMHS were assessed throughout the body using DXA and QCT. Results indicated that methods and applications of BMD in injury biomechanics are largely inconsistent, and that only 40% of studies assessed bone quality with injurious PMHS testing. aBMD differed between almost every skeletal site (p<0.05) and, similarly, vBMD was different between most sites (p<0.05). Further, no singular measure from DXA or QCT represented global BMD throughout the body. Few relationships in BMD were found between DXA and QCT (p<0.05) at comparable sites. Variability in bone quality assessment methods may limit comparability of data within the field. Overall, assessing BMD for PMHS biomechanical testing requires standardized methods and comprehensive understanding of variability between/within skeletal elements of interest.
Keywords:
Bone quality assessment; CT; DXA; Imaging; Skeletal fracture