ArticlePloS one2019
A new finite element based parameter to predict bone fracture.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 40 citations in OpenAlex.
- Integration of Multi-Scale Predictive Tools of Bone Fragility: A Structural and Material Property Perspective.Materials (Basel, Switzerland) · 2025Review
- Finite Element Analysis of Stress Distribution in Canine Lumbar Fractures with Different Pedicle Screw Insertion Angles.Veterinary sciences · 2025Article
- A Novel Triad of Bio-Inspired Design, Digital Fabrication, and Bio-Derived Materials for Personalised Bone Repair.Materials (Basel, Switzerland) · 2024Review
- DXA beyond bone mineral density and the REMS technique: new insights for current radiologists practice.La Radiologia medica · 2024Review
- Review
- The relationship between bone strain index, bone mass, microarchitecture and mechanical behavior in human vertebrae: an ex vivo study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Article
- Osteoporosis and Covid-19: Detected similarities in bone lacunar-level alterations via combined AI and advanced synchrotron testing.Materials & design · 2023Article
- Assessment of DXA derived bone quality indexes and bone geometry parameters in early breast cancer patients: A single center cross-sectional study.Bone reports · 2023Article
- A New Microarchitecture-Based Parameter to Predict the Micromechanical Properties of Bone Allografts.Materials (Basel, Switzerland) · 2023Article
- Isolating the Role of Bone Lacunar Morphology on Static and Fatigue Fracture Progression through Numerical Simulations.Materials (Basel, Switzerland) · 2023Article
- The Bone Strain Index: An Innovative Dual X-ray Absorptiometry Bone Strength Index and Its Helpfulness in Clinical Medicine.Journal of clinical medicine · 2022Review
- Finite Element Assessment of Bone Fragility from Clinical Images.Current osteoporosis reports · 2021Review
- DXA-Based Bone Strain Index: A New Tool to Evaluate Bone Quality in Primary Hyperparathyroidism.The Journal of clinical endocrinology and metabolism · 2021Article
- Current Applications and Selected Technical Details of Dual-Energy X-Ray Absorptiometry.Medical science monitor : international medical journal of experimental and clinical research · 2021Review
- A Review on Multiscale Bone Damage: From the Clinical to the Research Perspective.Materials (Basel, Switzerland) · 2021Review
- Bone strain index as a predictor of further vertebral fracture in osteoporotic women: An artificial intelligence-based analysis.PloS one · 2021Article
- Prediction of osteoporotic fragility re-fracture with lumbar spine DXA-based derived bone strain index: a multicenter validation study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2021Article
- Beyond Bone Mineral Density: A New Dual X-Ray Absorptiometry Index of Bone Strength to Predict Fragility Fractures, the Bone Strain Index.Frontiers in medicine · 2020Review
- Artificial neural network analysis of bone quality DXA parameters response to teriparatide in fractured osteoporotic patients.PloS one · 2020Article
- Hip Structural Analysis and Bone Strain Index in Clinical Practice: Their Utility Beyond BMD.Indian journal of endocrinology and metabolismReview
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Dual Energy X-Ray Absorptiometry (DXA) is currently the most widely adopted non-invasive clinical technique to assess bone mineral density and bone mineral content in human research and represents the primary tool for the diagnosis of osteoporosis. DXA measures areal bone mineral density, BMD, which does not account for the three-dimensional structure of the vertebrae and for the distribution of bone mass. The result is that longitudinal DXA can only predict about 70% of vertebral fractures. This study proposes a complementary tool, based on Finite Element (FE) models, to improve the DXA accuracy. Bone is simulated as elastic and inhomogeneous material, with stiffness distribution derived from DXA greyscale images of density. The numerical procedure simulates a compressive load on each vertebra to evaluate the local minimum principal strain values. From these values, both the local average and the maximum strains are computed over the cross sections and along the height of the analysed bone region, to provide a parameter, named Strain Index of Bone (SIB), which could be considered as a bone fragility index. The procedure is initially validated on 33 cylindrical trabecular bone samples obtained from porcine lumbar vertebrae, experimentally tested under static compressive loading. Comparing the experimental mechanical parameters with the SIB, we could find a higher correlation of the ultimate stress, σULT, with the SIB values (R2adj = 0.63) than that observed with the conventional DXA-based clinical parameters, i.e. Bone Mineral Density, BMD (R2adj = 0.34) and Trabecular Bone Score, TBS (R2adj = -0.03). The paper finally presents a few case studies of numerical simulations carried out on human lumbar vertebrae. If our results are confirmed in prospective studies, SIB could be used-together with BMD and TBS-to improve the fracture risk assessment and support the clinical decision to assume specific drugs for metabolic bone diseases.
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