Model Of Trabecular Bone Research Articles

Identifying a suitable material model to simulate the mechanical load transfer into the humeral bone in stemless shoulder endoprostheses

AbstractModern shoulder arthroplasties with stemless implants help to preserve the original bone substance of the proximal humerus and to reduce potential risks of conventional implants. Their shape allows newly formed bone to grow directly through the implant. However, it is not fully explained how an optimal fixation of the implant by formation of new bone can be achieved or stimulated. In this context, we develop a method to simulate the mechanical loading of the proximal humerus during the surgery using the finite element method to investigate whether one or more mechanical stress variables can be correlated with measurement data of cell activity in the bone, which is available in the form of SPECT/CT data. This contribution presents measurements with explanted humeral heads from patients undergoing planned total shoulder arthroplasties in order to parameterize a material model for trabecular bone to be used in the finite element simulation. The raw data of these measurements were published and can be accessed for further investigations.

Cortical and Trabecular Bone Modeling and Implications for Bone Functional Adaptation in the Mammalian Tibia.

Bone modeling involves the addition of bone material through osteoblast-mediated deposition or the removal of bone material via osteoclast-mediated resorption in response to perceived changes in loads by osteocytes. This process is characterized by the independent occurrence of deposition and resorption, which can take place simultaneously at different locations within the bone due to variations in stress levels across its different regions. The principle of bone functional adaptation states that cortical and trabecular bone tissues will respond to mechanical stimuli by adjusting (i.e., bone modeling) their morphology and architecture to mechanically improve their mechanical function in line with the habitual in vivo loading direction. This principle is relevant to various research areas, such as the development of improved orthopedic implants, preventative medicine for osteopenic elderly patients, and the investigation of locomotion behavior in extinct species. In the present review, the mammalian tibia is used as an example to explore cortical and trabecular bone modeling and to examine its implications for the functional adaptation of bones. Following a short introduction and an exposition on characteristics of mechanical stimuli that influence bone modeling, a detailed critical appraisal of the literature on cortical and trabecular bone modeling and bone functional adaptation is given. By synthesizing key findings from studies involving small mammals (rodents), large mammals, and humans, it is shown that examining both cortical and trabecular bone structures is essential for understanding bone functional adaptation. A combined approach can provide a more comprehensive understanding of this significant physiological phenomenon, as each structure contributes uniquely to the phenomenon.

Advancing 3D Dental Implant Finite Element Analysis: Incorporating Biomimetic Trabecular Bone with Varied Pore Sizes in Voronoi Lattices.

The human mandible's cancellous bone, which is characterized by its unique porosity and directional sensitivity to external forces, is crucial for sustaining biting stress. Traditional computer- aided design (CAD) models fail to fully represent the bone's anisotropic structure and thus depend on simple isotropic assumptions. For our research, we use the latest versions of nTOP 4.17.3 and Creo Parametric 8.0 software to make biomimetic Voronoi lattice models that accurately reflect the complex geometry and mechanical properties of trabecular bone. The porosity of human cancellous bone is accurately modeled in this work using biomimetic Voronoi lattice models. The porosities range from 70% to 95%, which can be achieved by changing the pore sizes to 1.0 mm, 1.5 mm, 2.0 mm, and 2.5 mm. Finite element analysis (FEA) was used to examine the displacements, stresses, and strains acting on dental implants with a buttress thread, abutment, retaining screw, and biting load surface. The results show that the Voronoi model accurately depicts the complex anatomy of the trabecular bone in the human jaw, compared to standard solid block models. The ideal pore size for biomimetic Voronoi lattice trabecular bone models is 2 mm, taking in to account both the von Mises stress distribution over the dental implant, screw retention, cortical bone, cancellous bone, and micromotions. This pore size displayed balanced performance by successfully matching natural bone's mechanical characteristics. Advanced FEA improves the biomechanical understanding of how bones and implants interact by creating more accurate models of biological problems and dynamic loading situations. This makes biomechanical engineering better.

Parametric design and performance study of continuous gradient triply periodic minimal surface bone scaffold

Continuous gradient triply periodic minimal surface (TPMS) porous structure has been proven to be one of the most suitable structures for bone implants due to their excellent mechanical properties and high porosity. This study establishes a parametric modeling method for continuous gradient TPMS structures and optimizes the TPMS porous structure with a continuous gradient change in porosity. Ti-6Al-4V continuous gradient TPMS porous structures were prepared using powder bed fusion (PBF). The mechanical properties and permeability of the continuous gradient TPMS porous structure were studied. The results indicate that the porosity control parameter C for gradient continuous change follows a linear function, with the porosity increasing linearly within the specified range of values. The influence of the periodic parameter ω on the mechanical properties and permeability of different types of TPMS structures varies. The Gyroid continuous gradient structure aligns more closely with the mechanical properties and permeability of bone scaffolds. Furthermore, a TPMS continuous gradient porous structure that is more suitable for trabecular bone implants was obtained through topology optimization design. A bone implant model and object suitable for human trabecular bone were designed and printed, providing technical support for subsequent performance testing and application research of bone implants.

An improved trabecular bone model based on Voronoi tessellation

Background and objectiveAccurate numerical and physical models of trabecular bone, correctly representing its complexity and variability, could be highly advantageous in the development of e.g. new bone-anchored implants due to the limited availability of real bone. Several Voronoi tessellation-based porous models have been reported in the literature, attempting to mimic the trabecular bone. However, these models have been limited to lattice rod-like structures, which are only structurally representative of very high-porosity trabecular bone. The objective of this study was to provide an improved model, more representative of trabecular bone of different porosity. MethodsBoolean operations were utilized to merge scaled Voronoi cells, thereby introducing different structural patterns, controlling porosity and to some extent anisotropy. The mechanical properties of the structures were evaluated using analytical estimations, numerical simulations, and experimental compression tests of 3D-printed versions of the structures. The capacity of the developed models to represent trabecular bone was assessed by comparing some key geometric features with trabecular bone characterized in previous studies. ResultsThe models gave the possibility to provide pore interconnectivity at relatively low porosities as well as both plate- and rod-like structures. The mechanical properties of the generated models were predictable with numerical simulations as well as an analytical approach. The permeability was found to be better than Sawbones at the same porosity. The models also showed the capability of matching e.g. some vertebral structures for key geometric features. ConclusionsAn improved numerical model for mimicking trabecular bone structures was successfully developed using Voronoi tessellation and Boolean operations. This is expected to benefit both computational and experimental studies by providing a more diverse and representative structure of trabecular bone.

Solitary wave-based site-specific bone quality assessment: A numerical study of the proximal femur

We examine numerically the feasibility of using a relatively new solitary wave-based non-destructive test (NDT) method for site-specific bone quality assessment. Towards this end, we present numerical predictions of the effective elastic modulus of trabecular bone in the proximal femur using highly nonlinear solitary waves (HNSWs) propagating in a one-dimensional chain of spherical steel particles. A computational bone reconstruction technique, enabled through topology optimization, is developed to generate high-resolution finite-element models representing the complex architecture of the trabecular network in the femoral neck region of the proximal femur. The reconstructed bone microstructure models are then used as the inspection medium in a virtual NDT setup in the form of a hybrid discrete-element/finite-element (DE/FE) model, capable of simulating the propagation of HNSWs in the granular chain and their interaction with the bone microstructures. By inserting a face sheet between the granular chain and the porous trabecular bone model, our calculations evince that dynamic loading by the incident solitary wave results in nearly uniaxial deformation of the bone microstructure (rather than localized contact indentations), and this is shown to enhance the accuracy and reliability of the solitary wave-based prediction of the bone’s effective elastic modulus. Using the delay of the primary reflected solitary wave in the estimation of the elastic modulus of bone, we are able to estimate the effective elastic moduli of the porous bone models with adequate accuracy. Based on these numerical findings, we believe that solitary wave-based non-destructive evaluation of computationally reconstructed artificial bone models could form the baseline for advanced bone quality assessment tools.

MULTI-SPECIES BONE ANALYSIS USING HIGH RESOLUTION MICRO-CT FOR IN VITRO BONE MODEL DEVELOPMENT

This study aimed to characterise the microarchitecture of bone in different species of animal leading to the development of a physiologically relevant 3D printed cellular model of trabecular (Tb) and cortical bone (CB). Using high resolution micro-computed tomography (μ-CT) bone samples from multiple species were scanned and analysed before creating in silico models for 3D printing. Biologically relevant printing materials with physical characteristics similar to that of in vivo bone will be selected and tested for printability.Porcine and murine bone samples were scanned using μ-CT, with a resolution of 4.60 μM for murine and 11 μM for porcine and reconstructed to determine the architectural properties of both Tb and CB independently. A region of interest, 1 mm in height, will be used to generate an in-silico 3D model with dimensions (10 mm3) and suitable resolution before being translated into printable G code using CAD assisted software.A 1 mm section of each bone was analysed, to determine the differences in the microarchitecture with the intent of setting a benchmark for the developmental 3D in vitro model to be comparable against. In contrast, porcine caudal vertebrae (PCV) have an increased volume due to the size of the bone sample. Interestingly, BV/TR for Tb is similar between species in all samples except murine femur. Murine tibia and PCV have a similar Tb. number and thickness, however different SMI shape and separation.μ-CT scanning and analysis permits tessellation of the 3D output which will lead to the generation of an in silico printable model. Biomaterials are currently under optimisation to allow printability and shape integrity to reflect the morphological and physiological properties of bone.

A morphological, topological and mechanical investigation of gyroid, spinodoid and dual-lattice algorithms as structural models of trabecular bone

In this study, we evaluate the performance of three algorithms as computational models of trabecular bone architecture, through systematic evaluation of morphometric, topological, and mechanical properties. Here, we consider the widely-used gyroid lattice structure, the recently-developed spinodoid structure and a structure similar to Voronoi lattices introduced here as the dual-lattice. While all computational models were calibrated to recreate the trabecular tissue volume (e.g. BV/TV), it was found that both the gyroid- and spinodoid-based structures showed substantial differences in many other morphometric and topological parameters and, in turn, showed lower effective mechanical properties compared to trabecular bone. The newly-developed dual-lattice structures better captured both morphometric parameters and mechanical properties, despite certain differences being evident their topological configuration compared to trabecular bone. Still, these computational algorithms provide useful platforms to investigate trabecular bone mechanics and for designing biomimetic structures, which could be produced through additive manufacturing for applications that include bone substitutes, scaffolds and porous implants. Furthermore, the software for the creation of the structures has been added to the open source toolbox GIBBON and is therefore freely available to the community.

Multi-scale constitutive model of human trabecular bone

The present study aims to formulate a new multiscale constitutive model of human trabecular bone. The trabecular bone was modelled as a nonlinear viscoelastic material. The viscoelastic effects of single trabeculae were considered by means of a hereditary integral in which stress depends on time and strain, while the elastic response was described by the hyperelastic Mooney–Rivlin model. The cuboid bone sample was extracted from the femoral head during the hip replacement surgery. The material constants in the constitutive equation were identified based on the stress relaxation test performed on the cuboid sample and the microindentation tests performed on trabeculae using the curve-fitting procedure. The microindentation tests were performed using a spherical tip instead of Vickers or Berkovich tip to minimize plastic effects during trabecular deformation. In order to validate formulated constitutive model, results from a FE simulation of stress relaxation test and uniaxial compression test were compared to the results of the corresponding experiments conducted on a macroscopic bone sample. Good agreement was observed between numerical and experimental results. The viscoelastic behaviour predicted by the proposed constitutive equation corresponds well to the response of human trabecular bone under various types of load conditions. This demonstrates the high ability of our constitutive model to simulate the behaviour of trabecular bone on a micro- and macroscopic scale. Thus, we conclude that the model, which was formulated for a single trabecula, can be successfully applied to simulate mechanical behaviour of the tissue in a macroscale.

Heterogeneous material mapping methods for patient-specific finite element models of pelvic trabecular bone: A convergence study

Patient-specific finite element (FE) models of bone require the assignment of heterogeneous material properties extracted from the subject's computed tomography (CT) images. Though node-based (NB) and element-based (EB) material mapping methods (MMMs) have been proposed, the sensitivity and convergence of FE models to MMM for varying mesh sizes are not well understood. In this work, CT-derived and synthetic bone material data were used to evaluate the effect of MMM on results from FE analyses. Pelvic trabecular bone data was extracted from CT images of six subjects, while synthetic data were created to resemble trabecular bone properties. The numerical convergence of FE bone models using different MMMs were evaluated for strain energy, von-Mises stress, and strain. NB and EB MMMs both demonstrated good convergence regarding total strain energy, with the EB method having a slight edge over the NB. However, at the local level (e.g., maximum stress and strain), FE results were sensitive to the field type, MMM, and the FE mesh size. The EB method exhibited superior performance in finer meshes relative to the voxel size. The NB method converged better than did the EB method for coarser meshes. These findings may lead to higher-fidelity patient-specific FE bone models.

Mesh-independent damage model for trabecular bone fracture simulation and experimental validation.

We propose in this study a two-dimensional constitutive model for trabecular bone combining continuum damage with embedded strong discontinuity. The model is capable of describing the three failure phases of trabecular bone tissue which is considered herein as a quasi-brittle material with strains and rotations assumed to be small and without viscous, thermal or other non-mechanical effects. The finite element implementation of the present model uses constant strain triangle (CST) elements. The displacement jump vector is implicitly solved through a return mapping algorithm at the local (finite element) level, while the global equilibrium equations are dealt with by Newton-Raphson method. The performance, accuracy and applicability of the proposed model for trabecular bone fracture are evaluated and validated against experimental measurements. These comparisons include both global and local aspects through numerical simulations of three-point bending tests performed on 10 single bovine trabeculae in the quasi-static regime.

Effect of isotretinoin on induced tooth movement in rats

This study was performed to evaluate the effect of isotretinoin on tooth displacement and tissues related to induced tooth movement (ITM) in rats. Wistar rats were randomly divided into 4 groups: vegetable oil (O; n=40), 7.5mg/kg isotretinoin (I; n=40), vegetable oil+ITM (OM; n=44), and 7.5mg/kg isotretinoin and ITM (IM; n=39). After the daily application of the solutions for 30days, an orthodontic appliance was installed to mesially displace the maxillary first right molar (30cN) of rats in the OM and IM groups. The animals were killed 2, 7, 14, or 21days after placement of the devices. The animals in the O and I groups did not undergo ITM but were killed simultaneously. The animals were examined for tooth displacement, the neoformation of mature collagen, bone and root resorption, the presence of hyalinized areas, and trabecular bone modeling by microcomputed tomography. There was no difference in tooth displacement, the number of osteoclasts, the presence of hyalinized areas, or trabecular bone among the O, I, OM, and IM groups across the periods tested (P>0.05). A lower percentage of mature collagen was found in the IM group than in the OM group on day 7 (P<0.05). A lower frequency of root resorption was found in the IM group than in the OM group on days 2 and 21 (P<0.05). Isotretinoin at 7.5mg/kg decreased root resorption in rats subjected to ITM.

Activation of Bone Remodeling Compartments in BMP-2-Injected Knees Supports a Local Vascular Mechanism for Arthritis-Related Bone Changes.

Synovial membrane-derived factors are implicated in arthritis-related bone changes. The route that synovial factors use to access subchondral bone and the mechanisms responsible for these bone changes remain unclear. A safety study involving intra-articular injection of bone morphogenetic protein-2 (BMP-2)/calcium phosphate matrix (CPM) or CPM addresses these issues. Knee joints in 21 monkeys were injected with CPM or 1.5 or 4.5 mg/mL BMP-2/CPM and were evaluated at 1 and 8 weeks. Contralateral joints were injected with saline solution. Knee joints in 4 animals each were injected with 1.5 or 4.5 mg/mL BMP-2/CPM. Contralateral joints were injected with corresponding treatments at 8 weeks. Both joints were evaluated at 16 weeks. Harvested joints were evaluated grossly and with histomorphometry. Knee joints in 3 animals were injected with 125I-labeled BMP-2/CPM and evaluated with scintigraphy and autoradiography at 2 weeks to determine BMP-2 distribution. All treatments induced transient synovitis and increased capsular vascularization, observed to anastomose with metaphyseal venous sinusoids, but did not damage articular cartilage. Both treatments induced unanticipated activation of vascular-associated trabecular bone remodeling compartments (BRCs) restricted to injected knees. Bone volume increased in BMP-2/CPM-injected knees at 8 and 16 weeks. Scintigraphy demonstrated metaphyseal 125I-labeled BMP-2 localization restricted to injected knees, confirming local rather than systemic BMP-2 release. Autoradiography demonstrated that BMP-2 diffusion through articular cartilage into the metaphysis was blocked by the tidemark. The lack of marrow activation or de novo bone formation, previously reported following metaphyseal BMP-2/CPM administration, confirmed BMP-2 and synovial-derived factors were not free in the marrow. The 125I-labeled BMP-2/CPM, observed within venous sinusoids of injected knees, confirmed the potential for capsular and metaphyseal venous portal communication. This study identifies a synovitis-induced venous portal circulation between the joint capsule and the metaphysis as an alternative to systemic circulation and local diffusion for synovial membrane-derived factors to reach subchondral bone. This study also identifies vascular-associated BRCs as a mechanism for arthritis-associated subchondral bone changes and provides additional support for their role in physiological trabecular bone remodeling and/or modeling. Inhibition of synovitis and accompanying abnormal vascularization may limit bone changes associated with arthritis.

Investigating the correlation between bone density and fracture frequency in the mandibular condyle with micro-computed tomography

Fractures of the mandibular condyle are common and include diacapitular fractures that affect the condylar head. The medial part of the condylar head is least commonly fractured, possibly due to decreased propensity for lines of force to run in the region. Micro-computed tomography (X-ray microtomography) of five temporomandibular joint specimens was conducted to explore whether trabecular bone structure correlates positively with fracture prevalence, which could reflect adaptation in response to lower exposure to physiological loads throughout life. Models of trabecular bone, and graphic representation of bone density indicated least dense bone medially, but a statistically significant ANOVA result was not obtained. Further study is required to verify whether a relationship between bone microstructure and fracture frequency exists, and whether or not this is the product of association between the directions of physiological and traumatic forces.

Estimating tissue-level properties of porcine talar subchondral bone

Tissue-level properties of bone play an important role when characterising apparent-level bone biomechanical behaviour and yet little is known about its effect at this hierarchical level. In combination with trabecular morphological data these properties can be used to predict bone strength, which becomes an invaluable tool for clinicians in patient treatment planning.This study developed specimen-specific micro-finite element (μFE) models using validated continuum-level models, containing grayscale-derived material properties, to indirectly establish tissue-level properties of porcine talar subchondral bone.Specimen-specific continuum finite element (hFE) models of subchondral trabecular bone were setup using μCT data of ten cylindrical specimens extracted from juvenile porcine tali. The models were validated using quasi-static uniaxial compression testing. Validated hFE models were used to calibrate the tissue modulus of corresponding μFE models by minimising the difference between the μFE and hFE stiffness values. Key trabecular morphological indices (BV/TV, DA, Conn.D, Tb.Th, EF) were evaluated.Good agreement was observed between hFE models and experiment (CCC = 0.66). Calibrated Etiss was 504 ± 37.65 MPa. Average BV/TV and DA for μFE specimens were 0.37 ± 0.05 and 0.68 ± 0.11, respectively. BV/TV (r2 = 0.667) correlated highly with μFE stiffness.The small intra-specimen variation to tissue-level properties suggests that variations to apparent-level stiffness originate from variations to microarchitecture rather than tissue mechanical properties.

3D-printed PLA/HA composite structures as synthetic trabecular bone: A feasibility study using fused deposition modeling

Additive manufacturing has significant advantages, in the biomedical field, allowing for customized medical products where complex architectures can be achieved directly. While additive manufacturing can be used to fabricate synthetic bone models, this approach is limited by the printing resolution, at the level of the trabecular bone architecture. Therefore, the aim of this study was to evaluate the possibilities of using fused deposition modeling (FDM) to this end. To better mimic real bone, both in terms of mechanical properties and biodegradability, a composite of degradable polymer, poly(lactic acid) (PLA), and hydroxyapatite (HA) was used as the filament. Three PLA/HA composite formulations with 5-10-15 wt% HA were evaluated, and scaled up human trabecular bone models were printed using these materials. Morphometric and mechanical properties of the printed models were evaluated by micro-computed tomography, compression and screw pull out tests. It was shown that the trabecular architecture could be reproduced with FDM and PLA by applying a scaling factor of 2–4. The incorporation of HA particles reduced the printing accuracy, with respect to morphology, but showed potential for enhancement of the mechanical properties. The scaled-up models displayed comparable, or slightly enhanced, strength compared to the commonly used polymeric foam synthetic bone models (i.e. Sawbones). Reproducing the trabecular morphology by 3D printed PLA/HA composites appears to be a promising strategy for synthetic bone models, when high printed resolution can be achieved.

Hole in One: an element reduction approach to modeling bone porosity in finite element analysis.

Finite element analysis has been an increasingly widely applied biomechanical modeling method in many different science and engineering fields over the last decade. In the biological sciences, there are many examples of FEA in areas such as paleontology and functional morphology. Despite this common use, the modeling of trabecular bone remains a key issue because their highly complex and porous geometries are difficult to replicate in the solid mesh format required for many simulations. A common practice is to assign uniform model material properties to whole or portions of models that represent trabecular bone. In this study we aimed to demonstrate that a physical, element reduction approach constitutes a valid protocol for addressing this problem in addition to the wholesale mathematical approach. We tested a customized script for element reduction modeling on five exemplar trabecular geometry models of carnivoran temporomandibular joints, and compared stress and strain energy results of both physical and mathematical trabecular modeling to models incorporating actual trabecular geometry. Simulation results indicate that that the physical, element reduction approach generally outperformed the mathematical approach: physical changes in the internal structure of experimental cylindrical models had a major influence on the recorded stress values throughout the model, and more closely approximates values obtained in models containing actual trabecular geometry than solid models with modified trabecular material properties. In models with both physical and mathematical adjustments for bone porosity, the physical changes exhibit more weight than material properties changes in approximating values of control models. Therefore, we conclude that maintaining or mimicking the internal porosity of a trabecular structure is a more effective method of approximating trabecular bone behavior in finite element models than modifying material properties.

Separate modeling of cortical and trabecular bone offers little improvement in FE predictions of local structural stiffness at the proximal tibia

Quantitative computed tomography-based finite element (QCT-FE) modeling has potential to clarify the role of altered subchondral bone stiffness in osteoarthritis. The objective of this research was to evaluate different QCT-FE modeling and thresholding approaches to identify the method which best predicted experimentally measured local subchondral structural stiffness with highest explained variance and least error. Our results showed that separate modeling of proximal tibial cortical and trabecular bone offered little improvement in QCT-FE-predicted stiffness (0% to +3% improvement in explained variance) when compared to modeling the proximal tibia as a single structure. Based on the results of this study, we do not recommend separate modeling of cortical bone and trabecular bone when developing QCT-FE models of the proximal tibia for predicting subchondral bone stiffness.

Volumetric Bioprinting of Complex Living-Tissue Constructs within Seconds.

Biofabrication technologies, including stereolithography and extrusion-based printing, are revolutionizing the creation of complex engineered tissues. The current paradigm in bioprinting relies on the additive layer-by-layer deposition and assembly of repetitive building blocks, typically cell-laden hydrogel fibers or voxels, single cells, or cellular aggregates. The scalability of these additive manufacturing technologies is limited by their printing velocity, as lengthy biofabrication processes impair cell functionality. Overcoming such limitations, the volumetric bioprinting of clinically relevant sized, anatomically shaped constructs, in a time frame ranging from seconds to tens of seconds is described. An optical-tomography-inspired printing approach, based on visible light projection, is developed to generate cell-laden tissue constructs with high viability (>85%) from gelatin-based photoresponsive hydrogels. Free-form architectures, difficult to reproduce with conventional printing, are obtained, including anatomically correct trabecular bone models with embedded angiogenic sprouts and meniscal grafts. The latter undergoes maturation in vitro as the bioprinted chondroprogenitor cells synthesize neo-fibrocartilage matrix. Moreover, free-floating structures are generated, as demonstrated by printing functional hydrogel-based ball-and-cage fluidic valves. Volumetric bioprinting permits the creation of geometrically complex, centimeter-scale constructs at an unprecedented printing velocity, opening new avenues for upscaling the production of hydrogel-based constructs and for their application in tissue engineering, regenerative medicine, and soft robotics.

Gaucher Disease in Bone: From Pathophysiology to Practice.

ABSTRACTGaucher disease (GD) is a rare, genetic lysosomal disorder leading to lipid accumulation and dysfunction in multiple organs. Involvement of the skeleton is one of the most prevalent aspects of GD and a major cause of pain, disability, and reduced quality of life. Uniform recommendations for contemporary evaluation and management are needed. To develop practical clinical recommendations, an international group of experienced physicians conducted a comprehensive review of 20 years’ of the literature, defining terms according to pathophysiological understanding and pointing out best practice and unmet needs related to the skeletal features of this disorder. Abnormalities of bone modeling, reduced bone density, bone infarction, and plasma cell dyscrasias accompany the displacement of healthy adipocytes in adult marrow. Exposure to excess bioactive glycosphingolipids appears to affect hematopoiesis and the balance of osteoblast and osteoclast numbers and activity. Imbalance between bone formation and breakdown induces disordered trabecular and cortical bone modeling, cortical bone thinning, fragility fractures, and osteolytic lesions. Regular assessment of bone mineral density, marrow infiltration, the axial skeleton and searching for potential malignancy are recommended. MRI is valuable for monitoring skeletal involvement: It provides semiquantitative assessment of marrow infiltration and the degree of bone infarction. When MRI is not available, monitoring of painful acute bone crises and osteonecrosis by plain X‐ray has limited value. In adult patients, we recommend DXA of the lumbar spine and left and right hips, with careful protocols designed to exclude focal disease; serial follow‐up should be done using the same standardized instrument. Skeletal health may be improved by common measures, including adequate calcium and vitamin D and management of pain and orthopedic complications. Prompt initiation of specific therapy for GD is crucial to optimizing outcomes and preventing irreversible skeletal complications. Investing in safe, clinically useful, and better predictive methods for determining bone integrity and fracture risk remains a need. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.