title: A method for patient-specific evaluation of vertebral cancellous bone strength: in vitro validation.
abstract: BACKGROUND
  In the context of osteoporosis, important determinants of the fracture risk are the apparent strength and stiffness of cancellous bone, as well as its brittleness and energy absorption capacity. Standard medical imaging, however, cannot measure these mechanical properties directly. Consequently, an estimation of the risk for fracture is made by correlating relative density or mineral density at a skeletal site with statistics of fracture occurrence, which provides limited and partial indications on fracture risks. A better method for evaluating the patient-specific mechanical properties of cancellous bone is therefore required.
  
  
  METHODS
  In order to asses the mechanical properties of vertebral cancellous bone, we developed a finite element parametric model of lattice trabecular architecture that, in the future, will be suitable for use with bone imaging modalities. The model inputs are apparent morphological parameters (trabecular thickness and trabecular separation) and the bone mineral density. We conducted uniaxial compression tests on 36 canine vertebral cancellous bone specimens (C7 and L1) to validate model predictions of strength and stiffness in vitro.
  
  
  RESULTS
  Predictions of strength and stiffness matched the experimental results within relative absolute errors of 17.7% and 12.8%, respectively (average of differences between model-predicted and measured values, divided by the average of measured values). We also employed the model for evaluation of strength and stiffness of human L1 and L5 vertebrae and found mean strength of 1.67 MPa (confidence interval 0.42 MPa) and mean elastic modulus of 190 MPa (confidence interval 50 MPa), which are well within the range of previously reported apparent strength and stiffness properties.
  
  
  CONCLUSIONS
  The present model can be used to improve medical imaging-based evaluation of the spine in osteoporotic individuals by providing more specific information on the individual bone's susceptibility to fracture once clinical bone scans will be able to provide more reliable measures of trabecular thickness and separation.
authors.affiliation: Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Diamant
authors.forename: R
authors.initials: R
authors.lastname: Shahar
authors.forename: Y
authors.initials: Y
authors.lastname: Masharawi
authors.forename: A
authors.initials: A
authors.lastname: Gefen
mesh_terms: D000818:Animals; D004285:Dogs; D020342:Finite Element Analysis; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis*; D018570:Risk Assessment; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D013131:Spine / Q000502:physiology*; D013314:Stress, Mechanical