Site-Dependent Reference Point Microindentation Complements Clinical Measures for Improved Fracture Risk Assessment at the Human Femoral Neck.

In contrast to traditional approaches to fracture risk assessment using clinical risk factors and Bone Mineral Density (BMD), a new technique, Reference Point micro-Indentation (RPI), permits direct assessment of bone quality; in vivo tibial RPI measurements appear to discriminate patients with a fragility fracture from controls. However, it is unclear how this relates to the site of the most clinically devastating fracture, the femoral neck, and whether RPI provides information complementary to that from existing assessments. Femoral neck samples were collected at surgery following low trauma hip fracture (n?=?46; 17 male, 83 (IQR 77-87) years), and compared, using RPI (Biodent HfcTM), with 16 cadaveric control samples, free from bone disease (7 male; 65 (IQR 61-74) years). A subset of fracture patients returned for Dual-energy X-ray Absorptiometry (DXA) assessment (Hologic Discovery) and, for the controls, a micro-computed tomography setup (HMX, Nikon) was used to replicate DXA scans. The indentation depth was greater in femoral neck samples from osteoporotic fracture patients than controls (p? In conclusion, RPI at the femoral neck discriminated fracture cases from controls independent of BMD and traditional risk factors but dependent on location. The clinical RPI device may, therefore, supplement risk assessment, and requires testing in prospective cohorts and comparison between the clinically accessible tibia and the femoral neck. This article is protected by copyright. All rights reserved