Clinical proxy for bone fracture risk in osteoporosis

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Today, clinical indicators of a possible bone fracture risk are vague - the current diagnostic criteria ofosteoporosis leave the autonomy and life quality of millions of people to chance. This proposal aims to resolvethe problem of characterization of spongy bone (most commonly affected by osteoporosis) based on clinicaltomographic imaging. This will be the first time that a new set of architectural parameters of spongy(trabecular) bone derived from a 3D image are used to provide a reliable prognosis to osteoporosis patients, asopposed to the traditionally-used bone mineral density or bone volume parameters. The proposal is based onthe recent discovery that healthy trabecular bone conforms to the topological principle of spanning maximal 3Dvolume with the minimal number of interconnected elements, akin to securing a sail mast to a boat deck with afew evenly spread ropes, rather than with the ropes pulling in one direction, or with a redundantly high numberof ropes. This topological principle reflects the adaptation of bone for effective re-distribution of diverse loadsand avoiding stress concentrations, both at the lowest metabolic cost. The topological descriptors of trabecularbone can be accessed via the novel inter-trabecular angle (ITA) analysis. This project will focus on detectionand analysis of variation of the topological parameters in healthy and osteoporotic trabecular bone. We havepreliminary evidence that such variation does exist and can be quantified. Following the definition of the rangebetween topologically stable and unstable configurations of trabecular bone, simulation of clinical imaging willbe carried out and an automated clinical application for medical tomography will be designed. The envisionedend result of this project will be an intuitive application ready for clinical validation and a supporting databaseof normal and pathological bone 3D images. This is especially relevant for developed countries where thehigh-longevity population succumbs to sedentary life style and metabolic diseases.