Abstract
Fragility fractures, those fractures which result from low level trauma, have a large and growing socio‐economic cost in countries with aging populations. Bone‐density‐based assessment techniques are vital for identifying populations that are at higher risk of fracture, but do not have high sensitivity when it comes to identifying individuals who will go on to have their first fragility fracture. We are developing Spatially Offset Raman Spectroscopy (SORS) as a tool for retrieving chemical information from bone non‐invasively in vivo. Unlike X‐ray‐based techniques SORS can retrieve chemical information from both the mineral and protein phases of the bone. This may enable better discrimination between those who will or will not go on to have a fragility fracture because both phases contribute to bone's mechanical properties. In this study we analyse excised bone with Raman spectroscopy and multivariate analysis, and then attempt to look for similar Raman signals in vivo using SORS. We show in the excised work that on average, bone fragments from the necks of fractured femora are more mineralised (by 5–10%) than (cadaveric) non‐fractured controls, but the mineralisation distributions of the two cohorts are largely overlapped. In our in vivo measurements, we observe similar, but as yet statistically underpowered, differences. After the SORS data (the first SORS measurements reported of healthy and diseased human cohorts), we identify methodological developments which will be used to improve the statistical significance of future experiments and may eventually lead to more sensitive prediction of fragility fractures. © 2015 The Authors. Journal of Raman Spectroscopy Published by John Wiley & Sons, Ltd.
Highlights
Fragility fractures, those fractures which result from low level trauma, have a large and growing socio-economic cost in countries with aging populations
Being diagnosed with osteoporosis does not guarantee that a fracture will occur, and having normal bone density is no guarantee that a fracture will not occur.[2]
In our previous work[6] we have shown that a bone spectrum can be successfully removed from in vivo Spatially Offset Raman Spectroscopy (SORS) data using parallel factor analysis, but in the present study, in which we had to make do with smaller data sets, we found that the best spectral decomposition was achieved with Band Target Entropy Minimisation (BTEM).[31,32,33]
Summary
Those fractures which result from low level trauma, have a large and growing socio-economic cost in countries with aging populations. In the UK, over 70 000 hip fractures occur annually, and the total cost of associated care is over £2 billion. The sufferers of these fractures have 10% mortality in the 30 days after the event and up to 30% mortality within a year.[1]. The bones of those considered to be at risk of a first fragility fracture are often assessed with X-ray radiation, with a bone’s density, or areal density, being predictive of its likelihood to fracture. Being diagnosed with osteoporosis does not guarantee that a fracture will occur, and having normal bone density is no guarantee that a fracture will not occur.[2]
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