Abstract
Purpose of ReviewBone matrix exhibits great complexity in its composition, structure and mechanics. Here, we provide a review of recent research articles and appraise the evidence that bone matrix quality is clinically important and possibly targetable for fracture prevention.Recent FindingsDeformation of mineralised collagen fibrils determines bone fracture mechanics. Slipping and separation at the mineral-fibril and fibril-fibril interfaces, respectively, are the structural mechanisms for plastic deformation and microcrack nucleation. Existing technologies for assessing bone tissue in vivo cannot measure matrix structure or fracture mechanics but have shown limited use in clinical settings for identifying fragility or following treatment outcomes based on composition.SummaryMatrix is biomechanically and clinically important, but the knowledge has not translated into clinical practice. The structural mechanisms by which a load is transferred from mineralised collagen fibrils to the whole bone via microcracking have been proven too complex to measure in vivo. The mineral-fibril or fibril-fibril interfaces might be suitable targets for diagnosing fragility or delivering molecules that reduce fracture risk by strengthening the mineral bonds while maintaining flexibility in the fibrils.
Highlights
Understanding the composition, structure and mechanics of the matrix could be key to improving fracture risk prediction and prevention including identifying new treatment targets
Bone matrix is made from arrays of mineralised fibrils which are coated by extrafibrillar mineral platelets and glued together by an extrafibrillar matrix which fills the spaces in between
Given the apparent importance of matrix in initiating and propagating fractures, it seems very plausible that mineralfibril mechanics could be targeted to assess bone fracture risk or monitor treatments outcomes
Summary
Understanding the composition, structure and mechanics of the matrix could be key to improving fracture risk prediction and prevention including identifying new treatment targets. Since the concept of bone quality appeared at the beginning of the 21st century [1, 2], a growing body of evidence has shown that strength and fragility are influenced by the interplay between mass, structure and material [3]. Diagnostics or treatments based on bone material have not filtered through into clinical practice, even though mass and structure have been widely adopted in clinical decision
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