Handheld microindentation - a direct assessment of bone fracture risk

骨质疏松性骨折对患者和整个社会来说都是一个日益严重的问题。英国国家医疗服务体系每年已经花费超过10亿英镑用于治疗骨质疏松性骨折患者，随着预期寿命的不断延长，越来越多的患者需要治疗。据估计，50岁以上的女性中有三分之一和男性中有五分之一会患骨质疏松性骨折。然而，目前缺乏有效的诊断，最常用的骨矿物质密度或骨量评估使用x射线技术似乎对个别患者是不准确的。在某种程度上，问题的根源在于骨量是一种替代品，不能解释骨的质量和材料特性的变化，而这些变化可能与骨矿物质密度无关。因此，补充检查可显著提高骨质疏松症和骨质减少症的诊断，有助于早期发现和治疗。最近，在一组患者的初步研究中使用了微压痕。压痕患者的胫骨可以清楚地识别出最近骨质疏松性骨折的患者。虽然这是有益的，但需要进一步的研究来了解骨量、微压痕测量和体外骨组织脆弱性的常规评估之间的相关性。我们建议购买微压痕设备，这将是英国第一个进行进一步研究的设备，目的是判断潜在的未来用于筛选患者和实验室研究。

Osteoporotic fractures are a major and increasing problem for both patients and society as a whole. The NHS is already spending well over a £1bn a year for treating patients with osteoporotic fractures and with the ever increasing life expectancy more and more patients will need treatment. It is estimated that 1 in 3 women over fifty and 1 in 5 men will suffer from an osteoporotic fracture. Yet an effective diagnosis is lacking to this point and the most commonly used assessment of bone mineral density or bone mass using X-ray techniques is seemingly inaccurate for individual patients. In part the problem is originating from the fact that bone mass is a surrogate and dose not account for the quality of bone and changes in material properties, which may be independent of bone mineral density. Therefore complementary tests could improve the diagnosis significantly and help in early identification and treatment of osteoporosis and osteopenia. Recently a microindentation was used in a pilot study on a cohort of patients. Indenting patient's tibiae that could clearly identify patients that had a recent osteoporotic fracture from a group of controls. While this is informative, further research is required to understand the correlation between bone mass, microindentation measurements and conventional assessment of in vitro bone tissue fragility. We propose ot acquire a microindentation device, which would be the first one in the UK to conduct further studies with the aim to judge potential future use for screening of patients and for laboratory studies.