Evaluation of the mechanical properties of bone with consideration of its microarchitecture
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1 Research Collection Doctoral Thesis Evaluation of the mechanical properties of bone with consideration of its microarchitecture Author(s): Ulrich, Dieter Publication Date: 1998 Permanent Link: Rights / License: In Copyright - Non-Commercial Use Permitted This page was generated automatically upon download from the ETH Zurich Research Collection. For more information please consult the Terms of use. ETH Library
2 'Mss.ETH e*. B Diss. ETHNr Evaluation of the Mechanical Properties of Bone with Consideration of its Microarchitecture Dissertation for the degree of DOCTOR OF THE TECHNICAL SCIENCES of the SWISS FEDERAL INSTITUTE OF TECHNOLOGY ZURICH, SWITZERLAND presented by DIETER ULRICH Dipl. Masch. Ing. ETH born on June 15, 1969 citizen of Kiissnacht a. R. (Sz), Switzerland Accepted on the recommendation of Prof. Dr. P. Niederer, examiner Prof. Dr. P. Riiegsegger, co-examiner 1998
3 compared Abstract Metabolic bone diseases such as osteoporosis cause a decrease in bone mass and a de terioration of bone microarchitecture. This degenerative process induces a decline in the mechanical properties of bone, and thus increases the bone fragility. Associated bone fractures, commonly occurring in the spine, hip, or wrist, cause significant mor tality and often result in pain and disability, affecting a large part of the elderly popula tion. For these reasons osteoporotic bone fractures constitute a major public health problem. Prevention of osteoporotic fractures requires accurate diagnostic methods to detect the increase in bone fragility at an early disease stage as well as effective thera pies to reduce the risk of bone fractures. Presently, however, the prediction of the patient-specific bone fracture risk is not very precise. The work presented in this thesis aims to contribute to the development of a better diagnostic method to quantify bone fragility. Fracture risk is determined by the mechanical properties and by the external loading conditions of the bone. Current methods to estimate fracture risk are primarily based on bone density, the sole property which can clinically be measured in a non-invasive way. With these methods, fracture risk can only be estimated with limited accuracy since bone microarchitecture and loading conditions are not accounted for. Recently, a new approach, combining computational engineering methods (finite element (FE) method) and 3-D high-resolution imaging techniques, has been introduced which can account for microarchitecture and loading conditions. High-resolution imaging tech niques allow acquisition of 3-D images of the bone microarchitecture, whereas FE methods applied to these images allow very precise calculation of the mechanical properties of bone. However, such a detailed FE analysis was not feasible for bone in vivo mainly because the resolution was not sufficient to measure the bone microarchitecture. Only recently, new in vivo high-resolution imaging techniques have been introduced which provide a resolution sufficient to resolve the bone network. The objectives of this work are to investigate the ability of the FE approach to evaluate the in vivo mechanical behavior of bone from in vivo high-resolution imaging and to ex plore if the new approach can provide additional and relevant information for a better bone fracture risk prediction. In the first chapters of the thesis, the new FE approach is used in combination with 3-D micro computed tomography (CT) to calculate the mechanical properties of hu man cancellous bones samples from different sites to validate the method. It is shown that the FE approach - to methods based on bone density alone - provides
4 new and additional information about the mechanical properties and the anisotropy of cancellous bone. In the following chapters, the FE approach is extended to complete end sections of bones using high-resolution 3-D CT images from a novel patient scan ner. For the first time a detailed 3-D FE model of a human distal radius is presented which is based on in vivo high-resolution CT imaging. The load transfer through the trabecular network of this radius is calculated in response to realistic external loading conditions. High loads are found in a region where Colles-fractures commonly occur. The 3-D CT based FE approach now allows prediction of the mechanical behavior of peripheral bones in vivo. It is expected that, eventually, the FE approach will lead to a better patient-specific fracture risk prediction than earlier methods based on bone density alone. Hence, with this new approach, it might be possible to detect the in crease in bone fragility at an early stage of osteoporosis and it might also be possible to evaluate treatments more accurately.
5 Zusammenfassung Metabolische Knochenkrankheiten wie Osteoporose fuhren zum Abbau von Knochenmasse und zur Zerstorung der Knochenmikroarchitektur. Dieser degenerative Prozess verschlechtert die mechanischen Eigenschaften von Knochen und erhoht deshalb das Knochenbruchrisiko. Folgliche Knochenfrakturen, die gewohnlich in der Wirbelsaule, in der Hiifte, oder im Handgelenk auftreten, erhohen significant die Sterblichkeitsquote und fuhren oft zu Schmerzen und Behinderung. Da ein grosser Anteil der alteren Bevolkerung betroffen ist, sind osteoporotische Knochenbriiche ein gewichtiges Volksgesundheitsproblem. Die Prevention von diesen Bruchen ist moglich durch genaue diagnostische Methoden zur Friiherkennung des erhohten Bruchrisikos sowie durch effektive Therapien, die das Bruchrisiko reduzieren. Zur Zeit ist allerdings die Diagnose des individuellen Bruchrisikos nicht sehr genau. Die hier vorgestellte Doktorarbeit zielt auf die bessere Vorhersage des Knochenbruchrisikos. Das Bruchrisiko beruht sowohl auf die mechanischen Knocheneigenschaften als auch auf die externen Belastungen des Knochens. Heutige Methoden zur Abschatzung des Bruchrisikos basieren vor allem auf der Knochendichte, der einzigen Eigenschaft, die nichtinvasiv gemessen werden kann. Mit diesen Methoden kann das Bruchrisiko nur mit einer limitierten Genauigkeit bestimmt werden, da die Mikroarchitektur und die externen Belastungen des Knochens nicht berucksichtigt werden. Seit kurzer Zeit gibt es eine Methode, welche Mikroarchitektur und Belastungen des Knochens beriicksichtigen kann. Die Methode kombiniert Computeringenieurmethoden (Finite Element (FE) Analyse) mit 3-D hochauflosenden bildgebenden Verfahren. Die hochauflosenden bildgebenden Verfahren ermoglichen eine Erfassung von 3-D Bildern der Knochernnikroarchitektur, wahrend die FE Analyse eine genaue Berechnung der mechani schen Eigenschaften von Knochen erlaubt. Bis jetzt konnte das bildbasierte FE-Verfahren allerdings nicht in vivo angewendet werden, vor allem da die Auflosung nicht ausreichte, um die Mikroarchitektur zu messen. Erst kurzlich wurden hochauflosende bildgebende Verfahren entwickelt, die das trabekulare Netzwerk in vivo erfassen konnen. Die vorliegende Arbeit hat zwei Ziele. Es wird untersucht, in wie weit das neue bildbasierte FE-Verfahren verwendet werden kann, um das mechanische Vernalten von Knochen in vivo zu ermitteln. Zum zweiten wird untersucht, ob das Verfahren neue und relevante Informationen erbringt fur eine bessere Diagnose des Knochen bruchrisikos. Im ersten Kapitel dieser Dissertation werden die neuen FE Methoden in Kombination mit 3-D Micro Computer Tomographic (CT) angewendet. Damit werden die me-
6 chanischen Eigenschaften von Knochenproben an verschiedenen Stellen des menschli- - chen Skeletts berechnet. Es zeigt sich, dass das bildbasierte FE-Verfahren verglichen mit herkommlichen, dichtebasierten Methoden - neuartige Informationen liefert iiber die mechanischen Eigenschaften und Anisotropie von trabekularem Knochen. In den folgenden Kapiteln wird das Verfahren angewendet auf ganze Knochenendabschnitte unter Einbeziehung von 3-D hochauflosenden CT Bildern von einem neuen Patientenscanner. Zura ersten Mai wird ein detailliertes FE Modell von einem menschlichem distalen Radius, basierend auf einer hochauflosenden in vivo CT Messung, vorgestellt. Der Kraftefluss durch das trabekulare Netzwerk des Radius wird berechnet unter Einbezug von realistischen ausseren Belastungen. Hohe Spannungen wurden genau dort gefunden, wo Colles-Frakturen gewohnlicherweise auftreten. Das 3-D CT-bildbasierte FE-Verfahren erlaubt zum ersten Mai die Bestimmung des mechanischen Verhaltens von peripheren Knochen in vivo unter Beriicksichtigung der Mikroarchitektur. Es wird erwartet, dass das neue Verfahren zu einer besseren Diagno se des individuellen Bruchrisikos fuhren wird als herkommliche, dichtebasierte Metho den. Damit sollte es schon in friihen Stadien von Osteoporose moglich werden Behandlungen praventiv und angemessen zu konzipieren.
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