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Granke et al. NMR- and RPI-derived clinical surrogates for fracture risk assessment
DOI:10.1038/bonekey.2015.129
Granke et al. used femurs obtained from 62 human cadaver donors to identify potential clinical surrogates that could be used to provide information on fracture toughness and how this varies with age.
Specimens of cortical bone were assessed for fracture toughness using 1H nuclear magnetic resonance spectroscopy (NMR), and reference point indentation (RPI) using the R-curve method. The results revealed weak to moderate correlations between fracture toughness and water content using the NMR method and with total indentation depth using RPI. The same degree of correlation between fracture toughness and porosity and pentosidine content were demonstrated by microCT and HPLC respectively.
The strongest correlation for overall fracture toughness, crack initiation and crack growth was demonstrated for NMR-derived bound water. Using multivariate analyses the authors suggest that assessment of the decrease in fracture toughness properties due to aging could be measured using NMR combined with RPI. These methods could be used to improve the accuracy of fracture risk assessment in the aging population.
Editor’s comment: Fracture toughness is an important factor that determines whether a bone cracks and whether the crack is able to propagate. While the correlation between fracture toughness and NMR-derived bound water is encouraging, it remains to be verified if bound water is truly independent of porosity and therefore independent of local BMD.
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