{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:49:39Z","timestamp":1790614179281,"version":"4.1.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2013,5,23]],"date-time":"2013-05-23T00:00:00Z","timestamp":1369267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,12,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2003<\/jats:title>\n                  <jats:p>More accurate techniques to estimate fracture risk could help reduce the burden of fractures in postmenopausal women. Although micro-finite element (\u00b5FE) simulations allow a direct assessment of bone mechanical performance, in this first clinical study we investigated whether the additional information obtained using geometrically and materially nonlinear \u00b5FE simulations allows a better discrimination between fracture cases and controls. We used patient data and high-resolution peripheral quantitative computed tomography (HRpQCT) measurements from our previous clinical study on fracture risk, which compared 100 postmenopausal women with a distal forearm fracture to 105 controls. Analyzing these data with the nonlinear \u00b5FE simulations, the odds ratio (OR) for the factor-of-risk (yield load divided by the expected fall load) was marginally higher (1.99; 95% confidence interval [CI], 1.41\u20132.77) than for the factor-of-risk computed from linear \u00b5FE (1.89; 95% CI, 1.37\u20132.69). The yield load and the energy absorbed up to the yield point as computed from nonlinear \u00b5FE were highly correlated with the initial stiffness (R2\u2009=\u20090.97 and 0.94, respectively) and could therefore be derived from linear simulations with little loss in precision. However, yield deformation was not related to any other measurement performed and was itself a good predictor of fracture risk (OR, 1.89; 95% CI, 1.39\u20132.63). Moreover, a combined risk score integrating information on relative bone strength (yield load-based factor-of-risk), bone ductility (yield deformation), and the structural integrity of the bone under critical loads (cortical plastic volume) improved the separation of cases and controls by one-third (OR, 2.66; 95% CI, 1.84\u20134.02). We therefore conclude that nonlinear \u00b5FE simulations provide important additional information on the risk of distal forearm fractures not accessible from linear \u00b5FE nor from other techniques assessing bone microstructure, density, or mass. \u00a9 2013 American Society for Bone and Mineral Research.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/jbmr.1996","type":"journal-article","created":{"date-parts":[[2013,5,23]],"date-time":"2013-05-23T13:14:18Z","timestamp":1369314858000},"page":"2601-2608","source":"Crossref","is-referenced-by-count":43,"title":["Improved Fracture Risk Assessment Based on Nonlinear Micro-Finite Element Simulations From HRpQCT Images at the Distal Radius"],"prefix":"10.1093","volume":"28","author":[{"given":"David","family":"Christen","sequence":"first","affiliation":[{"name":"Institute for Biomechanics, ETH ZurichZurichSwitzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"L Joseph","family":"Melton","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism and Nutrition, Department of Internal MedicineCollege of Medicine, Mayo ClinicRochesterMNUSA"},{"name":"Division of Epidemiology, Department of Health Sciences ResearchCollege of Medicine, Mayo ClinicRochesterMNUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Zwahlen","sequence":"additional","affiliation":[{"name":"Institute for Biomechanics, ETH ZurichZurichSwitzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreyasee","family":"Amin","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal MedicineCollege of Medicine, Mayo ClinicRochesterMNUSA"},{"name":"Division of Epidemiology, Department of Health Sciences ResearchCollege of Medicine, Mayo ClinicRochesterMNUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sundeep","family":"Khosla","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism and Nutrition, Department of Internal MedicineCollege of Medicine, Mayo ClinicRochesterMNUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Institute for Biomechanics, ETH ZurichZurichSwitzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2013,5,23]]},"reference":[{"issue":"9319","key":"2024020318325492800_jbmr1996-bib-0001","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/S0140-6736(02)08657-9","article-title":"Epidemiology and outcomes of osteoporotic fractures","volume":"359","author":"Cummings","year":"2002","journal-title":"Lancet."},{"issue":"1","key":"2024020318325492800_jbmr1996-bib-0002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S8756-3282(01)00697-4","article-title":"Age-related changes in the collagen network and toughness of bone","volume":"31","author":"Wang","year":"2002","journal-title":"Bone."},{"key":"2024020318325492800_jbmr1996-bib-0003"},{"key":"2024020318325492800_jbmr1996-bib-0004","doi-asserted-by":"crossref","first-page":"2250","DOI":"10.1056\/NEJMra053077","article-title":"Bone quality\u2014the material and structural basis of bone strength and fragility","volume":"354","author":"Seeman","year":"2006","journal-title":"N Engl J Med."},{"key":"2024020318325492800_jbmr1996-bib-0005","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.rcl.2010.02.015","article-title":"High-resolution imaging techniques for the assessment of osteoporosis","volume":"48","author":"Krug","year":"2010","journal-title":"Radiol Clin North Am."},{"key":"2024020318325492800_jbmr1996-bib-0006","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/j.medengphy.2006.11.002","article-title":"Accuracy of high-resolution peripheral quantitative computed tomography for measurement of bone quality","volume":"29","author":"MacNeil","year":"2007","journal-title":"Med Eng Phys."},{"key":"2024020318325492800_jbmr1996-bib-0007","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.bone.2008.10.045","article-title":"Non-invasive bone competence analysis by high-resolution pQCT: an in vitro reproducibility study on structural and mechanical properties at the human radius","volume":"44","author":"Mueller","year":"2009","journal-title":"Bone."},{"issue":"6","key":"2024020318325492800_jbmr1996-bib-0008","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1016\/S8756-3282(02)00736-6","article-title":"Estimation of distal radius failure load with micro-finite element analysis models based on three-dimensional peripheral quantitative computed tomography images","volume":"30","author":"Pistoia","year":"2002","journal-title":"Bone."},{"key":"2024020318325492800_jbmr1996-bib-0009","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1359\/jbmr.070728","article-title":"Structural determinants of vertebral fracture risk","volume":"22","author":"Melton","year":"2007","journal-title":"J Bone Miner Res."},{"issue":"6","key":"2024020318325492800_jbmr1996-bib-0010","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/j.bone.2008.01.017","article-title":"Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method","volume":"42","author":"MacNeil","year":"2008","journal-title":"Bone."},{"issue":"3","key":"2024020318325492800_jbmr1996-bib-0011","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1359\/jbmr.071108","article-title":"Finite element analysis based on in vivo HR-pQCT images of the distal radius is associated with wrist fracture in postmenopausal women","volume":"23","author":"Boutroy","year":"2008","journal-title":"J Bone Miner Res."},{"key":"2024020318325492800_jbmr1996-bib-0012","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1016\/j.bone.2009.12.015","article-title":"Finite element analysis performed on radius and tibia HR-pQCT images and fragility fractures at all sites in postmenopausal women","volume":"46","author":"Vilayphiou","year":"2010","journal-title":"Bone."},{"key":"2024020318325492800_jbmr1996-bib-0013","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1002\/jbmr.562","article-title":"Individual trabecula segmentation (ITS)-based morphological analyses and microfinite element analysis of HR-pQCT images discriminate postmenopausal fragility fractures independent of DXA measurements","volume":"27","author":"Liu","year":"2012","journal-title":"J Bone Miner Res."},{"key":"2024020318325492800_jbmr1996-bib-0014","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1007\/s00198-009-1047-2","article-title":"Assessing forearm fracture risk in postmenopausal women","volume":"21","author":"Melton","year":"2010","journal-title":"Osteoporos Int."},{"key":"2024020318325492800_jbmr1996-bib-0015","first-page":"182","author":"Christen","year":"2012"},{"key":"2024020318325492800_jbmr1996-bib-0016","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s001980050073","article-title":"Long-term trends in the incidence of distal forearm fractures","volume":"8","author":"Melton","year":"1998","journal-title":"Osteoporos Int."},{"issue":"1","key":"2024020318325492800_jbmr1996-bib-0017","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/0021-9290(95)80008-5","article-title":"A new method to determine trabecular bone elastic properties and loading using micromechanical finite-element models","volume":"28","author":"van Rietbergen","year":"1995","journal-title":"J Biomech."},{"issue":"2","key":"2024020318325492800_jbmr1996-bib-0018","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.clinbiomech.2007.08.024","article-title":"Mathematical relationships between bone density and mechanical properties: a literature review","volume":"23","author":"Helgason","year":"2008","journal-title":"Clin Biomech."},{"key":"2024020318325492800_jbmr1996-bib-0019","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/S0021-9290(03)00071-X","article-title":"Trabecular bone modulus\u2013density relationships depend on anatomic site","volume":"36","author":"Morgan","year":"2003","journal-title":"J Biomech."},{"issue":"1","key":"2024020318325492800_jbmr1996-bib-0020","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S0021-9290(03)00257-4","article-title":"Comparison of the elastic and yield properties of human femoral trabecular and cortical bone tissue","volume":"37","author":"Bayraktar","year":"2004","journal-title":"J Biomech."},{"key":"2024020318325492800_jbmr1996-bib-0021","doi-asserted-by":"crossref","first-page":"956","DOI":"10.2106\/00004623-197557070-00013","article-title":"Contribution of collagen and mineral to the elastic-plastic properties of bone","volume":"57","author":"Burstein","year":"1975","journal-title":"J Bone Joint Surg Am."},{"key":"2024020318325492800_jbmr1996-bib-0022","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.jbiomech.2009.01.001","article-title":"Sensitivity of tissue differentiation and bone healing predictions to tissue properties","volume":"42","author":"Isaksson","year":"2009","journal-title":"J Biomech."},{"issue":"6","key":"2024020318325492800_jbmr1996-bib-0023","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1016\/j.bone.2006.06.016","article-title":"Influence of bone volume fraction and architecture on computed large-deformation failure mechanisms in human trabecular bone","volume":"39","author":"Bevill","year":"2006","journal-title":"Bone."},{"issue":"4","key":"2024020318325492800_jbmr1996-bib-0024","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/S8756-3282(03)00214-X","article-title":"On the importance of geometric nonlinearity in finite-element simulations of trabecular bone failure","volume":"33","author":"Stolken","year":"2003","journal-title":"Bone."},{"issue":"7","key":"2024020318325492800_jbmr1996-bib-0025","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1002\/nme.2101","article-title":"A scalable multi-level preconditioner for matrix-free mu-finite element analysis of human bone structures","volume":"73","author":"Arbenz","year":"2008","journal-title":"Int J Numer Methods Eng."},{"key":"2024020318325492800_jbmr1996-bib-0026","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1016\/S0021-9290(98)00137-7","article-title":"Prediction of upper extremity impact forces during falls on the outstretched hand","volume":"31","author":"Chiu","year":"1998","journal-title":"J Biomech."},{"key":"2024020318325492800_jbmr1996-bib-0027","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1016\/j.bone.2011.02.022","article-title":"Computational finite element bone mechanics accurately predicts mechanical competence in the human radius of an elderly population","volume":"48","author":"Mueller","year":"2011","journal-title":"Bone."},{"issue":"7","key":"2024020318325492800_jbmr1996-bib-0028","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1080\/10255842.2011.556627","article-title":"HR-pQCT-based homogenised finite element models provide quantitative predictions of experimental vertebral body stiffness and strength with the same accuracy as muFE models","volume":"15","author":"Pahr","year":"2012","journal-title":"Comput Methods Biomech Biomed Engin."},{"key":"2024020318325492800_jbmr1996-bib-0029","author":"R Development Core Team","year":"2012"},{"key":"2024020318325492800_jbmr1996-bib-0030","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1359\/jbmr.070514","article-title":"Contribution of in vivo structural measurements and load\/strength ratios to the determination of forearm fracture risk in postmenopausal women","volume":"22","author":"Melton","year":"2007","journal-title":"J Bone Miner Res."},{"key":"2024020318325492800_jbmr1996-bib-0031","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1359\/jbmr.061206","article-title":"Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, partially independent of decreased BMD measured by DXA: the OFELY study","volume":"22","author":"Sornay-Rendu","year":"2007","journal-title":"J Bone Miner Res."},{"key":"2024020318325492800_jbmr1996-bib-0032","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S0021-9290(01)00011-2","article-title":"Dependence of yield strain of human trabecular bone on anatomic site","volume":"34","author":"Morgan","year":"2001","journal-title":"J Biomech."},{"issue":"11","key":"2024020318325492800_jbmr1996-bib-0033","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1016\/j.jbiomech.2004.02.045","article-title":"Mechanisms of uniformity of yield strains for trabecular bone","volume":"37","author":"Bayraktar","year":"2004","journal-title":"J Biomech."},{"issue":"7","key":"2024020318325492800_jbmr1996-bib-0034","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/S0021-9290(98)00057-8","article-title":"Yield strain behavior of trabecular bone","volume":"31","author":"Kopperdahl","year":"1998","journal-title":"J Biomech."},{"issue":"10","key":"2024020318325492800_jbmr1996-bib-0035","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/S0021-9290(03)00125-8","article-title":"The dependence of the elastic properties of osteoporotic cancellous bone on volume fraction and fabric","volume":"36","author":"Homminga","year":"2003","journal-title":"J Biomech."},{"issue":"12","key":"2024020318325492800_jbmr1996-bib-0036","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1016\/S0021-9290(00)00149-4","article-title":"High-resolution finite element models with tissue strength asymmetry accurately predict failure of trabecular bone","volume":"33","author":"Niebur","year":"2000","journal-title":"J Biomech."},{"issue":"7","key":"2024020318325492800_jbmr1996-bib-0037","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1016\/j.jbiomech.2008.02.032","article-title":"Indirect determination of trabecular bone effective tissue failure properties using micro-finite element simulations","volume":"41","author":"Verhulp","year":"2008","journal-title":"J Biomech."}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjbmr.1996","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/28\/12\/2601\/56562503\/jbmr1996.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/28\/12\/2601\/56562503\/jbmr1996.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T14:49:40Z","timestamp":1710341380000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/28\/12\/2601-2608\/7598531"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,5,23]]},"references-count":37,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2013,5,23]]},"published-print":{"date-parts":[[2013,12,1]]}},"URL":"https:\/\/doi.org\/10.1002\/jbmr.1996","relation":{},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2013,12,1]]},"published":{"date-parts":[[2013,5,23]]}}}