Department of Systems Design Engineering, University of Waterloo, Waterloo, Canada.
Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada.
Curr Osteoporos Rep. 2023 Jun;21(3):253-265. doi: 10.1007/s11914-023-00789-4. Epub 2023 Apr 27.
This review surveys recent literature related to cortical bone fracture mechanics and its application towards understanding bone fragility and hip fractures.
Current clinical tools for hip fracture risk assessment have been shown to be insensitive in some cases of elevated fracture risk leading to the question of what other factors account for fracture risk. The emergence of cortical bone fracture mechanics has thrown light on other factors at the tissue level that are important to bone fracture resistance and therefore assessment of fracture risk. Recent cortical bone fracture toughness studies have shown contributions from the microstructure and composition towards cortical bone fracture resistance. A key component currently overlooked in the clinical evaluation of fracture risk is the importance of the organic phase and water to irreversible deformation mechanisms that enhance the fracture resistance of cortical bone. Despite recent findings, there is an incomplete understanding of which mechanisms lead to the diminished contribution of the organic phase and water to the fracture toughness in aging and bone-degrading diseases. Notably, studies of the fracture resistance of cortical bone from the hip (specifically the femoral neck) are few, and those that exist are mostly consistent with studies of bone tissue from the femoral diaphysis. Cortical bone fracture mechanics highlights that there are multiple determinants of bone quality and therefore fracture risk and its assessment. There is still much more to learn concerning the tissue-level mechanisms of bone fragility. An improved understanding of these mechanisms will allow for the development of better diagnostic tools and therapeutic measures for bone fragility and fracture.
本文综述了皮质骨骨折力学及其在理解骨脆性和髋部骨折方面的应用的最新文献。
目前用于髋部骨折风险评估的临床工具在某些情况下对骨折风险升高的敏感度不高，这就提出了一个问题，即还有哪些其他因素与骨折风险有关。皮质骨骨折力学的出现揭示了组织水平上对骨抗骨折性很重要的其他因素，因此对骨折风险的评估也很重要。最近的皮质骨断裂韧性研究表明，微观结构和组成对皮质骨抗断裂性有贡献。目前在骨折风险的临床评估中被忽视的一个关键因素是有机相和水对增强皮质骨抗断裂性的不可逆变形机制的重要性。尽管有最近的发现，但对于哪些机制导致衰老和骨降解疾病中有机相和水对断裂韧性的贡献减少，仍存在不完全的理解。值得注意的是，关于髋部（特别是股骨颈）皮质骨抗断裂性的研究很少，而且现有的研究大多与股骨骨干骨组织的研究一致。皮质骨骨折力学强调了有多个因素决定骨质量，因此也决定了骨折风险及其评估。关于骨脆性的组织水平机制，仍有很多需要了解。对这些机制的更好理解将有助于开发更好的诊断工具和治疗措施来治疗骨脆性和骨折。
