Probabilistic Fracture Research Articles

Flexural strains in a toughened glass panel generated by impact of an ice sphere

An analytical model for predicting flexural strains on a toughened glass panel generated by the impact of ice is presented in this paper. The time-history of the generated surface tensile strains can be used to predict the fracture probability of glass in a projected hailstorm scenario. As demonstrated in this article, the strain intensity is insensitive to changes in the panel size, positions of impact, and boundary conditions. The development of flexural strain at the point of contact is controlled purely by the initial generation of waves. This wave-controlled phenomenon can be explained by the early occurrence of the maximum flexural strain at the point of impact in advance of the arrival of reflected waves from the plate boundary. Thus, only the size of the ice sphere, impact velocity, temperature, and panel thickness are relevant to the prediction. The model for predicting flexural strain utilises considerably less computation time than numerical models. The derivation of expressions for predicting maximum strains involved investigations into the change in contact force and radius of the contact area with time. Integrating these relationships gave predictions of the maximum curvature and surface strains on the glass panel. The model has been validated by comparison of the simulated and measured quantities.

Influence of elevated temperature on the very high cycle fatigue properties of bearing steels

The influence of temperature on the very high cycle fatigue properties of three high carbon chromium bearing steels (52100, 52100-VIM/VAR and M50-VIM/VAR) is investigated. Ultrasonic fatigue tests up to more than 1010 cycles are performed at 22 °C, 200 °C and 300 °C. At all temperatures, the dominant failure mechanism is interior defect-initiated cracking. Nonmetallic inclusions are the origin of fracture for 52100 and carbides for 52100-VIM/VAR and M50-VIM/VAR. The fatigue strength (fracture probability of 50 % at 2 × 109 cycles) at 300 °C decreases by 56–57 % compared with 22 °C for both 52100 steels and by 41 % for M50. 52100 steels soften at elevated temperature due to low tempering temperature, but M50 is thermally stable. The hardness decrease at elevated temperature is more pronounced for 52100 steels than for M50.The results are evaluated applying fracture mechanics principles. Based on the area-parameter model, an equation to predict the fatigue strength in the VHCF regime at different temperatures is proposed.

The plastic strain effect on cleavage microcracks propagation

The effect of plastic strain by tension on microcracks propagation is investigated in probabilistic and deterministic statements on the basis of the experimental results for the critical brittle fracture stress and the calculations of brittle fracture probability with local approach model. Investigation is performed for two materials: 2Cr-Ni-Mo-V steel used for WWER-1000 RPV in the thermally-embrittled state and low-alloyed low-strength steel of St.3 grade taken as model material ruptured by cleavage up to plastic strain >50 %. Experimental study includes uniaxial tension of smooth round bars over wide temperature range, mainly over brittle fracture range, and SEM examination of the fracture surfaces. Brittle fracture probability is calculated with the Prometey model. It has been found that the plastic strain effect on the microcrack propagation probability is caused by two reasons: (1) the critical brittle fracture stress increase due to formation of new barriers for microcrack under plastic deformation, and (2) the working volume decrease due to the neck formation in tensile round bar. A procedure has been proposed to separate the above different contributions of plastic deformation in the brittle fracture probability.

Introducing a novel therapeutic supplement for osteoporosis: Remedial, cytotoxicity and antioxidant effects of plant extract green-formulated gold nanoparticles

Osteoporosis means a decrease in bone density, as a result of which bone strength decreases and becomes brittle, which increases the probability of fracture. Osteoporosis usually develops gradually and does not show any symptoms until a fracture occurs. Osteoporosis can occur in any bone of the body, but it is usually seen in the spine, pelvis, wrists, and ribs. Both men and women at any age may be affected by this disease, but according to statistics, the percentage of women suffering from osteoporosis is higher than men, and the probability of this disease increases with age. Recently, the metallic nanoparticles containing plant extracts have been used for the treatment of bone disorders such as osteoporosis. The obtained nanoparticle (Gold nanoparticles green-formulated by Glycine max L seed extract) was characterized by advanced chemical and physical techniques like TEM, FTIR, and SEM. The cytotoxicity effects of gold nanoparticles against normal cell line i.e. HUVEC were assessed. Administration of gold nanoparticles ‎following methyl prednisolone sodium succinate induced osteoporosis in Wistar rats indicated a raise in the bone mineral content markers serum levels and a reduction in bone resorption markers urinary and serum levels. An incline in tibia and femur strength was observed particularly with 5 µg/kg of gold nanoparticles‎. Calcium homeostasis maintenance, collagen formation and free radicals scavenging can plausibly be the gold nanoparticles action mode ‎thereby combating osteoporosis induced by glucocorticoids.

Thermally/mechanically robust anodic aluminum oxide (AAO) microheater platform for low power chemoresistive gas sensor

The semiconductor metal oxide gas sensors are getting high attention owing to their high sensitivities and fast responses. They require high temperature for the reaction with target gases, and suspended silicon membrane microheaters are typically used to reduce the heating power consumption. However, they have low durability for long-term uses, and high probability of fracture by thermal stress or mechanical impact. In this study, as an alternative to the silicon membrane microheater, anodic aluminum oxide (AAO)-based microheater platform gas sensor was fabricated for low power consumption and high thermal/mechanical stabilities. Nanoscale air gaps of the AAO substrate reduce the heat loss transferred to the substrate. Therefore, AAO-based microheater platforms do not require suspended structures sustained by very thin bridges, which dramatically enhances thermal/mechanical stabilities. The temperature of fabricated microheater platform reached to 250 °C by a heating power of 27.4 mW. The excellent thermal/mechanical stabilities of the AAO-based microheater platforms were verified by cyclic on-off and mechanical shock test. The pulsed heating operation was adopted, and it reduced the heating power consumption to 9 mW. The fabricated AAO-based gas sensors showed much higher responses to NO2 gas compared to the SiO2 membrane-based gas sensors.

Hemoglobin Levels Improve Fracture Risk Prediction in Addition to FRAX Clinical Risk Factors and Bone Mineral Density.

Anemia and decreasing levels of hemoglobin (Hb) have previously been linked to increased fracture risk, but the added value to FRAX, the most utilized fracture prediction tool worldwide, is unknown. To investigate the association between anemia, Hb levels, bone microstructure, and risk of incident fracture and to evaluate whether Hb levels improve fracture risk prediction in addition to FRAX clinical risk factors (CRFs). A total of 2778 community-dwelling women, aged 75-80 years, and part of a prospective population-based cohort study in Sweden were included. At baseline, information on anthropometrics, CRFs, and falls was gathered, blood samples were collected, and skeletal characteristics were investigated using dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. At the end of follow-up, incident fractures were retrieved from a regional x-ray archive. The median follow-up time was 6.4 years. Low Hb was associated with worse total hip and femoral neck bone mineral density (BMD), and lower tibia cortical and total volumetric BMD, and anemia was associated with increased risk of major osteoporotic fracture (MOF; hazard ratio 2.04; 95% CI 1.58-2.64). Similar results were obtained for hip fracture and any fracture, also when adjusting for CRFs. The ratio between 10-year fracture probabilities of MOF assessed in models with Hb levels included and not included ranged from 1.2 to 0.7 at the 10th and 90th percentile of Hb, respectively. Anemia and decreasing levels of Hb are associated with lower cortical BMD and incident fracture in older women. Considering Hb levels may improve the clinical evaluation of patients with osteoporosis and the assessment of fracture risk.

Romosozumab Efficacy in Postmenopausal Women With No Prior Fracture Who Fulfill Criteria for Very High Fracture Risk

ObjectiveWe evaluated the efficacy of romosozumab in women from FRAME who had no prior fracture but met other criteria for very high fracture risk (VHFR). MethodsIn FRAME, postmenopausal women received romosozumab or placebo for 12 months (year 1) followed by denosumab for 12 months (year 2). In this post hoc analysis, we applied the following criteria from the American Association of Clinical Endocrinology to define VHFR: lumbar spine or total hip T-score <−3.0 and/or Fracture Risk Assessment Tool probability of major osteoporotic fracture >30% or hip fracture >4.5% to women with no fracture history at baseline (no fracture-VHFR [NF-VHFR]). Incidence of new vertebral, clinical, and nonvertebral fractures and mean bone mineral density (BMD) percentage change from baseline were assessed at years 1 and 2. ResultsOf the 7180 women in FRAME, 2825 were included in the NF-VHFR subgroup analysis. At year 1, romosozumab versus placebo reduced the incidence of new vertebral fracture (relative risk reduction [RRR]: 76%), clinical fracture (RRR: 60%), and nonvertebral fracture (RRR: 54%) (all P <.05). This fracture reduction was maintained through year 2 in women receiving the romosozumab-to-denosumab sequence versus the placebo-to-denosumab sequence for new vertebral, clinical, and nonvertebral fractures (RRR: 77%, 54%, and 46%, respectively; all P <.05). The mean BMD changes in both treatment groups were similar to those in the overall FRAME population at years 1 and 2. ConclusionRomosozumab significantly reduced vertebral, clinical, and nonvertebral fracture risk and increased the BMD more than placebo in women at VHFR.

The application of FRAX in Ecuador

IntroductionIntervention thresholds for the treatment of osteoporosis have been based historically on the measurement of bone mineral density. The development of FRAX® has permitted more accurate assessment of fracture risk. ObjectiveThe aim of the present study was to explore treatment paths and characteristics of women eligible for treatment in Ecuador based on FRAX. Methodology and methodsA total of 2367 women aged 60–94 years were selected from the National Health, Welfare and Aging Survey (SABE) conducted in Ecuador. Probabilities of major osteoporotic and hip fracture were computed using the Ecuadorian FRAX model. The proportion of women eligible for treatment and bone mineral density assessment was determined based on age-specific intervention thresholds and a hybrid threshold was fixed from age 75 years. ResultsA total of 87 women (3.7%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 49 women were eligible for treatment in that MOF probabilities lay above the upper assessment threshold using age-specific thresholds. An BMD test would be recommended in 1131 women (48%) so that FRAX could be recalculated with the inclusion of femoral neck BMD. With the hybrid threshold, an additional 170 women were eligible for treatment and an BMD test recommended in 1218 women. ConclusionsThe hybrid threshold identifies more women eligible for treatment than age-specific thresholds. Although age-specific thresholds identify women at higher risk of fracture, the lower number of women identified results in fewer identified fracture cases.

FRAX-based intervention thresholds for men in the Russian Federation: Expert consensus of the Russian association on osteoporosis

According to the European guidelines for osteoporosis, the same FRAX intervention threshold is suggested for men as for women. At the same time, in the Russian Federation, according to research data, an extremely low proportion of identified men who are subject to the initiation of osteoporosis therapy. The female intervention threshold identifies only 1.1 to 4% of men for treatment. Aim – to develop and evaluate various options for the intervention threshold using the FRAX calculator for men in the Russian Federation and adopt the most acceptable intervention threshold by consensus. Material and methods. Delphi voting was conducted among 18 Russian experts who have publications and personal reports about their experience with the FRAX calculator. For discussion, 5 intervention threshold options with the corresponding rationale based on the literature reference were presented, as well as the proportion of men of different ages to be initiated in each of the options (based on several Russian population-based studies). Anonymous voting was carried out using the Delphi method with questionnaire placed in the Google form. It was proposed to evaluate all options for intervention thresholds on a 9-point Likert scale. Consensus was considered reached if the intervention threshold reached a Likert score of 7 or more points in 80% or more of the experts. The rating of each intervention threshold option was expressed as mean and standard deviations. Results. In the first round of voting, the maximum rating and percentage of agreement is reached for the 9% fixed interference threshold option based on the FRAX calculation. The rating was 7.72±1.6 points, the percentage of experts’ agreement was 88.9%. A fixed threshold of 9% determined 13–19.5% of men aged 50 years and older to be treated for osteoporosis, while their proportion increased to 26–38% at the age of 85 years and older. Conclusion. The consensus of experts of the Russian association on osteoporosis suggests initiating treatment of osteoporosis in Russian men with a 10-year probability of major osteoporotic fractures according to FRAX of 9% or higher.

Optimized calculator for a qualitative risk assessment of osteoporotic fractures for the population of Moscow

BACKGROUND: The FRAX tool (a 10-year fracture risk assessment) is recommended to diagnose osteoporosis and optimize the number of patients who need to undergo X-ray densitometry. Due to various circumstances, the integration of a full-fledged FRAX tool into the digital circuits of the Moscow City Health Department is problematic.&#x0D; AIM: The study aimed to develop a calculator of the 10-year probability of osteoporotic fractures to optimize the routing of patients for examination.&#x0D; METHODS: An optimized Half-FRAX calculator was created based on the FRAX tool from the University of Sheffield, which was developed using the results of population studies of the Russian Federation. All data used in the original FRAX algorithm, i.e. sex, age, height, weight, and T-criterion (if available) and other important parameters such as a history of fractures, parental hip fractures, smoking, rheumatoid arthritis, secondary osteoporosis, and glucocorticoid and alcohol intake were included in the risk assessment calculator. An algorithm for interaction with the FRAX website was developed and implemented to verify critical levels of patient stratification by multiple consecutive enumerations of different combinations of body mass index (BMI) measurements (0.1 discretization) and age (1-year discretization). Data from clinical guidelines were taken as thresholds.&#x0D; RESULTS: When implementing the developed algorithm by modeling various combinations of BMI, T-criterion, and risk factors (RF), the absence of RFs and BMI 25 (upper limit of normal) in women was shown to guarantee the exclusion from the orange zone where densitometry should be performed. In men, BMI was not a RF. If a RF was present, a patient was recommended to consult a doctor. If no T-criterion was present, but a RF was detected, the patient was indicated for densitometry. Similar results were reported for women with the same indices. In the absence of the RF and with a T-criterion 2.5, low fracture risk factor was indicated for both men and women.&#x0D; CONCLUSIONS: An optimized Half-FRAX calculator for the 10-year probability of major osteoporotic fractures was developed, which may optimize the routing of patients for densitometry and reduce the burden on radiology departments in Moscow. This will allow patients to be timely referred to the clinical specialists for consultations. Half-FRAX is integrated into the Osteoporosis Digital Platform (https://telemedai.ru/cifrovaya-platforma-osteoporoz/half-frax).

Investigation of the paper-type gas diffusion layer deformation behavior and fiber fracture

Paper-type gas diffusion layer (GDL) plays the role of structural support, mass transport, electron and heat transfer in the fuel cell. The deformation and fracture behavior of paper-type GDL directly determines its physical characteristics. In this paper, we obtained the distribution function of fiber length among intersections using statistical analysis. Based on the bending theory and fracture analysis, the deformation model and the maximum allowable pressure criterion of paper-type GDL are established. The deformation modulus is related to the modulus and the initial volume fraction of carbon fiber, with an ideal value of 1.4 MPa. The tensile fracture is the main form of fiber fracture. The maximum allowable pressure is related to the expected fracture probability, the strength and the initial volume fraction of carbon fiber. The residual strain increases and the deformation modulus decreases with load range, which means that the strength of the paper-type GDL is weakened when residual strain occurs.

Hierarchical Bayesian modeling to quantify fracture limit uncertainty of high-burnup advanced fuel cladding tubes under loss-of-coolant accident conditions

For realizing a highly reliable fracture limit evaluation of fuel cladding tubes during loss-of-coolant accidents (LOCAs) in light-water reactors, we developed a method to quantify the fracture limit uncertainty of high-burnup advanced fuel cladding tubes. This method employs a hierarchical Bayesian model that can quantify uncertainty even with limited experimental data. The hierarchical Bayesian model was an extended version of the fracture probability estimation model developed in our previous study. The fracture limit uncertainty was quantified as a probability using the amount of oxidation (Equivalent cladding reacted: ECR) and the initial hydrogen concentration (the hydrogen concentration in the fuel cladding tubes before the LOCA-simulated tests) as explanatory variables. We divided the regression coefficients of this model into a hierarchical structure with an overall average term common to all types of fuel cladding tubes and a term representing differences among various types of fuel cladding tubes. This hierarchical structure enabled us to quantify the fracture limit uncertainty through the effective use of prior knowledge and data, even for high-burnup advanced fuel cladding tubes with a small number of data points. The fracture limits representing a 5% fracture probability with 95% confidence of the high-burnup advanced fuel cladding tubes evaluated by the hierarchical Bayesian model were higher than 15% ECR for the initial hydrogen concentrations of up to 700–900wtppm and restraint loads below 535N. These fracture limits were comparable to the limit of the unirradiated Zircaloy-4 cladding tube, indicating that the burnup extension and use of the advanced fuel cladding tubes do not significantly lower the fracture limit of fuel cladding tubes. Further, we proposed a method to reduce the fracture limit uncertainty by using non-binary data, instead of the binary data, depending on the condition of the fuel cladding tube specimens after performing the LOCA-simulated test, thereby increasing the amount of information in the data.

Role of determining trabecular bone score for appointment of osteoporotic therapy (clinical case)

Numerous studies have shown that the trabecular bone score (TBS) in patients with rheumatic diseases and especially in persons receiving glucocorticoids predicts fractures better than the bone mineral density (BMD) of the spine or the value of a 10-year probability of osteoporotic fracture according to the FRAX calculator. This article describes the role of TBS in determining the indications for prescribing anti-osteoporotic treatment on the example of a clinical case of a postmenopausal woman with a confirmed diagnosis of rheumatoid arthritis and a slight decrease in BMD.

Management of osteoporosis in men based Ukrainian version of FRAX

Objective. The aim of the study was to evaluate the impact of the previous published FRAX thresholds in a male referral cohort from Ukraine. Methods. The cohort comprised 653 men aged 40‒88 years (mean age 60.5 ± 11.8). The 10-year probabilities of hip fracture and a major osteoporotic fracture werecalculated using the Ukrainian FRAX model. The intervention threshold was set at the age specific fracture probability as first used by the National Osteoporosis Guideline Group for FRAXbased guidelines in the UK and adapted for the Ukraine. Treatment pathways were compared with a previously published female referral cohort from Ukraine. Results. 27 % of men and 51 % of women referred for skeletal assessment had a prior fracture that categorized eligibility for treatment that was more frequent in women than in men. The requirement for BMD testing was also higher in women than in men (18.3 % vs. 4.9 %, respectively). If referral for fracture risk assessment was contingent on the presence of at least one FRAX risk, the proportion of men and women eligible for treatment would rise from 5 % to 89 % in men and from 57 % to 93 % in women. Conclusions. This study demonstrated a higher need for both antiosteoporotic treatment without DХA and additional densitometric examination to further assess the osteoporotic fractures risk in Ukrainian women compared to men and the need for special attention in fracture risk assessment in men with previous fractures. The developmentof National guidelines together with a validation based on cost-effectiveness would help drive a cohesive national approach to risk assessment in both men and women.

Optimal hinge level in opening wedge high tibial osteotomy: Biomechanical analysis using finite element method

BackgroundWhile the concept of a safe zone, which can minimize the hinge fracture when performing opening wedge high tibial osteotomy, has been introduced, there is a lack of understanding of the biomechanical environment at the lateral tibial cortex. This study aimed to evaluate the effect of the hinge level on the biomechanical environment at the lateral cortex of the tibia with heterogeneous finite element models. MethodsFinite element models of biplanar opening wedge high tibial osteotomy based on computed tomography images of a control subject and three patients with medial compartment knee osteoarthritis were created. In each model, three different hinge levels (proximal, middle, and distal) were set. The process of opening the gap during the operation was simulated, and the maximum von Mises stress values at the lateral tibial cortex were calculated for each hinge level and correction angle. FindingsThe maximum von Mises stress value at the lateral tibial cortex was the lowest when the hinge was at the middle, while the value was the highest when the hinge was at the distal level. Furthermore, it was demonstrated that a higher correction angle yielded a higher probability of lateral tibial cortex fracture. InterpretationThe findings of this study demonstrate that the hinge at the point where the upper end of the articular cartilage of the proximal tibiofibular joint is located provides the least possibility of lateral tibial cortex fracture, as this is an anatomically independent position from the fibula.

Discrepancies in type of first major osteoporotic fracture and anti-osteoporotic therapy in elderly people with type 2 diabetes mellitus: A retrospective Danish cohort study.

Subjects with diabetes mellitus have an increased risk of fractures. We aimed to identify discrepancies in the first type of major osteoporotic fracture (MOF) and anti-osteoporotic therapy between subjects with type 2 diabetes (T2D) and subjects without diabetes. Methods and research design. We conducted a retrospective national cohort study by access to all discharge diagnoses (ICD-10 system) and redeemed drug prescriptions (ATC classification system). We included all subjects alive and Danish citizens in 2010 and identified subjects with T2D diagnosed after the age of 50 between 1998 and 2018. Only subjects with a MOF after the index date were included in the main analysis. The type of MOF was identified by diagnosis codes and categorized into Humerus, Forearm, Spine, and Hip. Multinomial logistic regression modeling was used to assess the predicted probability changes in MOF type between T2D and control subjects. Data on first anti-osteoporotic therapy after the MOF was assessed by redeemed drug prescriptions. Mortality and time to therapy after the MOF were evaluated by cox proportional hazards. We included 26,588 subjects with T2D and 97,982 subjects without diabetes. The mean age was age 69.33 (±10.34) for T2D and 69.85 (±10.19) for control subjects. The cohort was primarily females (67%). Subjects with T2D had a higher probability of hip (3.98% [95% CI 3.29; 4.67]) and humerus (2.82% [95% CI 2.17; 3.46]) fractures as the first MOF compared to control subjects. However, the probability of forearm fractures as the first MOF was 6.77% (95% CI 6.08; 7.46) lower among subjects with T2D. The multiple adjusted hazard ratio for anti-osteoporotic treatment after the first MOF was 0.80 (95% CI 0.77; 0.88) for T2D compared to controls among treatment-naïve subjects. Forearm fractures were the most frequent type of MOF and were more prevalent in control subjects. Subjects with T2D had a significantly higher probability of hip and humerus fractures as the first MOF but had a 20% lower chance of anti-osteoporotic treatment afterwards.

Effect of compositional homogenization on hot workability of Ni-based GH4061 superalloy

Complex solidification process, severe chemical segregation and large amounts of secondary phases with low melting point between dendrites deteriorate the hot workability of as-cast GH4061 superalloy. The effects of the homogenization temperature and time on the dendritic segregation, dissolution behavior of Laves phase with low melting point intermetallic phases and hot workability of the alloy were investigated using OM, SEM, EPMA and TEM. The results show that in the as-cast sample, severe compositional segregation is found among dendritic structures and the highest segregation coefficient of Nb is 2.435, followed by Ti of 1.346 and Mo of 1.200. After homogenization at 1160 °C for 20 h, the segregation among dendritic structures has been fully eliminated and the segregation coefficient of Nb declines to 1.098. Meanwhile, Laves and δ phases are mostly dissolved and no any localized grain boundary re-melting was observed. Increasing annealing temperature accelerates the speed of chemical homogenization and dissolution of intermetallic compounds. High-temperature mechanical properties testing results demonstrate that two-step homogenization treatment promotes the plasticity up to 1150 °C. Fracture analysis reveals that the dissolution of Laves and δ phases reduces the probability of crack initiation and fracture, resulting in a good hot workability.

Size effect on the compressive mechanical properties of pearl with “brick-mortar” structure

The size dependence of four different diameters of pearls with “brick-mortar” structure was studied by uniaxial compression experiments. The results show that the failure of pearls with different diameters under the compressive load is not complete brittleness, but has a certain toughness. The maximum failure load and compressive strength of pearls cannot be considered as constants, which have a significant size dependence. The maximum failure load increases with the increase of pearl diameter, and the compressive strength decreases with the increase of pearl diameter. In addition, the compressive strength of pearls with different diameters conforms to the Weibull statistical law. When the compression fracture probability is 50%, the compressive strength of pearls with different diameters shows a significant size effect, and pearls with smaller diameters have greater compressive strength.

Jump Power Predicts Fracture Risk in Older Adults Independent of Sarcopenia and FRAX.

Low countermovement jump power is associated with prevalent fracture, osteoporosis, and sarcopenia in older adults. However, whether jump power predicts incident fracture risk remains uninvestigated. Data of 1366 older adults in a prospective community cohort were analyzed. Jump power was measured using a computerized ground force plate system. Fracture events were ascertained by follow-up interview and linkage to the national claim database (median follow-up 6.4 years). Participants were divided into normal and low jump power groups using a predetermined threshold (women <19.0 W/kg; men <23.8 W/kg; or unable to jump). Among the study participants (mean age 71.6 years, women 66.3%), low jump power was associated with a higher risk of fracture (hazard ratio [HR] = 2.16 versus normal jump power, p < 0.001), which remained robust (adjusted HR = 1.45, p = 0.035) after adjustment for fracture risk assessment tool (FRAX) major osteoporotic fracture (MOF) probability with bone mineral density (BMD) and Asian Working Group for Sarcopenia (AWGS) 2019 sarcopenia definition. In the AWGS no sarcopenia group, participants with low jump power had a significantly higher risk of fracture than those with normal jump power (12.5% versus 6.7%; HR = 1.93, p = 0.013), comparable to that of possible sarcopenia without low jump power (12.0%). Possible sarcopenia group with low jump power had a similar risk of fracture (19.3%) to sarcopenia group (20.8%). When the definition of sarcopenia was modified with jump power measurement (step-up approach: no sarcopenia to possible sarcopenia; possible sarcopenia to sarcopenia when low jump power present), jump power-modified sarcopenia improved sensitivity (18%-39.3%) to classify individuals who sustained MOF during follow-up to high risk compared with AWGS 2019 sarcopenia, while maintaining positive predictive value (22.3%-20.6%). In summary, jump power predicted fracture risk in community-dwelling older adults independently of sarcopenia and FRAX MOF probabilities, suggesting potential contribution of complex motor function measurement in fracture risk assessment. © 2023 American Society for Bone and Mineral Research (ASBMR).

Use of Distal Tibial Cortical Bone Thickness and FRAX Score for Further Treatment Planning in Patients with Trimalleolar Ankle Fractures.

A total of 193 patients with a trimalleolar ankle fracture treated between 2011 and 2020 were included. Patient registries were reviewed regarding demographics, mechanism, and type of injury. The CBTT was assessed in radiographs and CT images. The FRAX score was calculated to estimate the probability for an osteoporotic fracture. A multivariable regression model was calculated to identify independent variables affecting the cortical bone thickness of the distal tibia. Patients older than 55 years were 4.22 (95% CI: 2.12; 8.38) times more likely to be female. In the multivariable regression analysis, female sex (β -0.508, 95% CI: -0.739; -0.278, p < 0.001) and a higher age (β -0.009, 95% CI: -0.149; -0.003, p = 0.002) were independent variables associated with a lower CBTT. Patients with a CBTT < 3.5 mm had a higher 10-year probability for a major osteoporotic fracture (12% vs. 7.75%; p = 0.001). The assessment of the peripheral bone quality in routine computed tomography demonstrated that higher age and female sex are significantly associated with reduced cortical bone thickness of the distal tibia. Patients with a lower CBTT showed a higher probability for a subsequent osteoporotic fracture. In female patients with reduced distal tibial bone quality and associated risk factors, an osteoporosis assessment should be evaluated.