Fracture Response of Human Cortical Bone with Reduced Compositional Heterogeneity

Bisphosphonates, the most commonly used osteoporosis treatment, have been effective in preventing osteoporotic fractures by suppressing bone turnover. The recent reports of atypical femoral fracture and its possible association with prolonged bisphosphonate use brought into attention the possibility of adverse mechanical modifications in bone due to extensive suppression of bone turnover [1, 2]. One of these modifications has been identified as reduced compositional heterogeneity of the cortical bone [3, 4]. In a previous finite element study, we have shown the detrimental effects of homogeneous material distribution on fracture resistance of cortical bone using an idealized model [5]. In the current study, we aim to assess the fracture response of actual human cortical bones with reduced compositional heterogeneity and evaluate how previous findings on idealized models translate into actual human cortical bone. The results will establish the strength of this technique to evaluate the influence of material level changes on fracture resistance of actual human cortical bone and may provide additional insight into the association of AFF with prolonged