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The social costs of osteoporosis are huge and keep growing because of increased life expectancy. Although a low bone mineral density is considered to be associated with a higher risk of fracture, densitometry alone has been shown to be inadequate to predict a significant number of fractures, hence the need to develop innovative and inexpensive diagnostic methods to be used together with the consolidated systems. The Bone Structure Index is computed using a patented technique that virtually simulates the application of compressive loads on the trabecular structure’s reconstructions obtained from the patient’s digital radiographs. The radiograms are acquired by a hand-held portable x-ray system equipped with a digital sensor. This configuration presents specific advantages but the use of a handheld portable X-ray device requires safety procedures specifically designed to protect the operator and the patient, which are discussed in the present paper.

Early phase endocrine-expansive breast and prostate cancers are treated with post-operative adjuvant hormonal therapies and chemotherapeutic drugs that have a negative impact on bone heath, blocking estrogen or androgen activity and increasing bone turnover leading to a progressively higher risk of fractures. At present, DXA monitoring of bone loss is widely recommended in prostate and breast cancer patients, but most fractures occur in patients whose DXA result falls outside the osteoporosis ranges, indicating that DXA might not be the elective exam for evaluating the degree of fracture risk in terms of microarchitecture alterations. The recently introduced Bone Structure Index (BSI) gives an indication of the quality of the bone structure. In this work, we discuss the preliminary results obtained in the evaluation of the BSI in female patients undergoing breast cancer treatment

Osteoporosis is a silent disease, characterized by a decreasing bone strength, which leads to a progressive increase in fracture risk. As mean average human lifespan is growing, a parallel rise in the rate of osteoporosis is observed. Currently, diagnosis is made on the basis of bone mineral density, which seems to be a poor fracture predictor in about 40-50% of cases, and of clinical risk factors, but the trabecular structure arrangement should be evaluated as well. The BSI (Bone Structure Index) is a new index computed from simulated application of loads on a virtual biopsy of the patient. In this work, we aim to identify the distributions of BSI and of fragility fracture risk factors recognized by the scientific community in a population of over 300 female volunteers.

Densitometry alone has been shown to be inadequate to predict all osteoporotic fractures, since 40-50% occur in people who do not have a low bone density. The BESTEST®, Bone Elastic Structure Test, virtually simulates compressive loads on the trabecular architecture’s reconstructions obtained from digital radiographs of first proximal epiphyses of the non-dominant hand. The radiograms are acquired by a hand-held portable x-ray system equipped with a digital sensor. While in certain cases these systems present risks that are no greater than with standard systems, issues related to: (i) position of the handheld X-ray device relative to the operator, (ii) risk of misalignment of the X-ray units during exposure, (iii) patient protection and (iv) correct positioning of the sensor must still be addressed. A special stand and a customized sensor holder have been therefore designed, so that safety for patient and operator and repeatability of the exam have been improved.

“Why should a professor of mechanical engineering decide to study bone tissue? Well, simply because she is interested in preventing any kind of breakage, and fractures are not an exception!” I think enabling structures to resist the applied loads is an innate desire of all engineers. The complex and highly organized inner architecture of bones makes this challenge even more exciting. In such a complex material, loss of bone mass alone cannot justify all osteoporosis-related fractures. Being aware of this I decided to focus my research on the fracture risk assessment and the impact of the complex trabecular structure of bone on internal force distribution, the ultimate goal being to improve knowledge of each patient’s specific conditions.

Osteoporosis is a very common disease in which the bones become weak and easily break. Besides the serious impact on a person’s health and quality of life, osteoporosis results in important costs for society. The current diagnosis considers the bone quantity, as evaluated by bone mineral density assessments, and the clinical risk factors, but cannot take into account the bone quality, defined as the structural soundness of the trabecular arrangement. An approach based on the numerical modeling of the behavior of bone architectures, acquired by planar radiograms in the proximal phalanges of the non-dominant hand, has been developed at the University of Trieste. The Bone Structure Index, BSI, summarizes the simulations results for the purpose of bone quality ranking in the clinical evaluation. In this work, we discuss the preliminary design of a portable low dose x-ray scanner intended to be used as a low cost, user-friendly device for imaging the trabecular pattern and for providing a radiogram suitable for BSI evaluation. As an example, two cases in which the chosen device is used to evaluate the BSI are also reported.

Osteoporosis (OP) is a very common disease in which the bones become weak and are more likely to break. Despite the huge costs in the EU and worldwide, the majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are left untreated. In effect, OP is a silent disease, with bones deteriorating without warning until fracture, and the current screening modalities are not significantly better than age alone, also because they consider only the bone quantity (bone mineral density, BMD) and the clinical risk factors, but disregard the bone quality, that is the structural soundness of the trabecular arrangement, which can be evaluated by simulations on virtual models. While 3D models can only be used in research because of high costs, an alternative approach based on the acquisition of planar hand radiograms for bone behaviour simulations, and the use of a Structural Index, SI, for bone quality ranking, have been developed at the University of Trieste. In this work, we discuss the preliminary design of a portable low dose X-ray hand scanner to be used as a low cost, user-friendly device (Fig.1) for imaging the trabecular pattern in the proximal phalanges of the non-dominant hand and for providing a radiogram suitable for the SI evaluation.