{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:06:15Z","timestamp":1792785975662,"version":"4.5.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["NIAMS P30 AR072581"],"award-info":[{"award-number":["NIAMS P30 AR072581"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIH\u2019s National Institute on Aging","award":["NIAR44AG058312"],"award-info":[{"award-number":["NIAR44AG058312"]}],"id":[{"id":"https:\/\/ror.org\/049v75w11","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>DXA-derived areal BMD remains the clinical standard for assessing osteoporosis risk, yet it fails to identify over 75% of individuals who sustain fragility fractures. Direct in vivo mechanical assessment of cortical bone strength may address this diagnostic gap by capturing structural and material properties that govern whole-bone strength but are not reflected by BMD. We conducted a multicenter case-control study with cross-sectional exposure assessment to compare ulna flexural rigidity (EI), a biomechanical property correlated with whole-bone strength (R2\u2009\u2248\u20090.99), estimated using cortical bone mechanics technology (CBMT), with DXA-derived BMD for discriminating prior fragility fractures in postmenopausal women. A total of 372 women aged 50-80\u00a0yr (109 with low-trauma fractures and 263 matched controls) were enrolled across 4 U.S. sites. Ulna EI was assessed by dynamic vibrational analysis; BMD was measured at the spine, hip, and 1\/3 radius. Women with prior fractures had significantly lower EI than controls (absolute: 20.0 vs 24.8\u00a0N\u00b7m2; 21% lower; weight-normalized: 0.29 vs 0.36\u00a0N\u00b7m2\/kg; 22% lower; both p\u2009&amp;lt;\u2009.001). Cortical bone mechanics technology demonstrated good discriminatory accuracy (AUC\u2009=\u20090.80 normalized; 0.76 absolute), with significantly better AUCs than DXA, which showed only fair to poor performance (AUC\u2009\u2264\u20090.63). In multivariable models including CBMT and DXA-derived BMD, CBMT remained independently associated with fracture status, whereas BMD did not. Subgroup analyses showed CBMT retained good performance in treatment-na\u00efve women (AUC\u2009=\u20090.85) and in those with non-osteoporotic BMD (AUC\u2009=\u20090.80). Exploratory fracture-site analyses demonstrated that ulna EI discriminated upper and lower extremity fractures, including hip, whereas DXA-derived BMD generally showed fair to poor discrimination. Biomechanical assessment of bone rigidity provides clinically relevant information beyond areal BMD, including women not classified high risk. Direct in vivo assessment of cortical bone rigidity may enhance fracture risk stratification and enhance osteoporosis screening.<\/jats:p>","DOI":"10.1093\/jbmr\/zjag032","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:47:42Z","timestamp":1770900462000},"page":"1109-1122","source":"Crossref","is-referenced-by-count":2,"title":["In vivo mechanical assessment of cortical bone rigidity enhances fracture discrimination beyond DXA in postmenopausal women"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6021-6431","authenticated-orcid":false,"given":"Brian C","family":"Clark","sequence":"first","affiliation":[{"name":"Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University , Athens, OH 45701 ,","place":["United States"]},{"name":"Department of Biomedical Sciences, Ohio University , Athens, OH 45701 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd M","family":"Manini","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics, University of Florida , Gainesville, FL 32611 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet E","family":"Simon","sequence":"additional","affiliation":[{"name":"Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University , Athens, OH 45701 ,","place":["United States"]},{"name":"Department of Athletic Training, Ohio University , Athens, OH 45701 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leatha A","family":"Clark","sequence":"additional","affiliation":[{"name":"Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University , Athens, OH 45701 ,","place":["United States"]},{"name":"Department of Biomedical Sciences, Ohio University , Athens, OH 45701 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalampos","family":"Lyssikatos","sequence":"additional","affiliation":[{"name":"Indiana Center for Musculoskeletal Health, Indiana University School of Medicine , Indianapolis, IN 46202 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6415-4936","authenticated-orcid":false,"given":"Stuart J","family":"Warden","sequence":"additional","affiliation":[{"name":"Indiana Center for Musculoskeletal Health, Indiana University School of Medicine , Indianapolis, IN 46202 ,","place":["United States"]},{"name":"Department of Mechanical Engineering, University of Colorado , Boulder, CO 80309 ,","place":["United States"]},{"name":"Department of Physical Therapy, School of Health and Human Sciences, Indiana University , Indianapolis, IN 46202 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"2026092707515745900_ref1","first-page":"785","article-title":"NIH Consensus Development Panel on Osteoporosis Prevention D, Therapy. 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