Cortical pore size distribution and viscoelastic tibia properties discriminate fragility fractures independent of bone mineral density

Cortical pore size distribution and viscoelastic tibia properties discriminate fragility fractures independent of bone mineral density | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Cortical pore size distribution and viscoelastic tibia properties discriminate fragility fractures independent of bone mineral density Kay Raum, Gabriele Armbrecht, Huong Minh, Jonas Massmann This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-515087/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Osteoporosis is a disorder of bone remodeling leading to reduced bone mass, structural deterioration, and increased bone fragility. The established diagnosis is based on the measurement of areal bone mineral density by dual energy x-ray absorptiometry (DXA), which poorly captures individual bone loss and structural decay. Enlarged cortical pores in the tibia have been proposed to indicate structural deterioration and reduced bone strength in the hip. Here, we report for the first time the in-vivo assessment of the cortical pore size distribution together with viscoelastic bone properties by means of a novel ultrasonic cortical backscatter (CortBS) technology to discriminate between fractured and nonfractured postmenopausal women (N = 55). The discrimination performance was benchmarked with DXA and high-resolution peripheral computed tomography (HR-pQCT). The results suggest a superior discrimination performance of CortBS (area under the receiver operating characteristic curve: 0.69 ≤ AUC ≤ 0.75) compared to DXA (0.53 ≤ AUC ≤ 0.55) and a similar performance compared to HR-pQCT (0.68 ≤ AUC ≤ 0.73). Endocrinology & Metabolism Translational Medicine osteoporosis bone disorders bone mass bone fragility Full Text Due to technical limitations, full-text HTML conversion of this manuscript could not be completed. However, the manuscript can be downloaded and accessed as a PDF. Additional Declarations Yes there is potential Competing Interest. JM is employee of poroUS GmbH, a startup developing the CortBS technology. KR is inventor on the patent applications (EP3641657A1, US 2020/0129140, CN110769754A and JP 2019-570514) describing the CortBS technology. Supplementary Files Supplementarymaterialsformanuscript.pdf Supplementary Materials Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-515087","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":26662552,"identity":"4e70b5a9-9a5b-49cb-94f2-14b1eb033d9a","order_by":0,"name":"Kay Raum","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYBACCRiDn4EHSBqAmAlEapFsAGsxIEGLwQEeBqg1BLRItp8xYK6oORxtfPzswc8VBX/kGNiTD+DVIs2TY8B45tjh3G1n8pIlzxgYGDPwPMNvjRwDUEsDG1DLDR4DyQYDg8QGiRwD/Fr43wC1/Ducu3kGj/FPoJb6Bon8D/gdBjSTsbHtcO4GCR4zkC0JDBI5eHUwSM54VnCwsS89d8aZHDPLBgNjwzaeZ/gdJnE+eePDhm/Wuf3tZ4xvNvyRk+dnT36A3xoGDoMDKHw2AuqBgJ2QmaNgFIyCUTDiAQDCFUPtuAZqlAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-0573-1622","institution":"Charité-Universitätsmedizin Berlin","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Kay","middleName":"","lastName":"Raum","suffix":""},{"id":26662553,"identity":"cf7fbd84-1900-4f46-b1dc-be0fd4f9feae","order_by":1,"name":"Gabriele Armbrecht","email":"","orcid":"","institution":"Charité-Universitätsmedizin Berlin","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gabriele","middleName":"","lastName":"Armbrecht","suffix":""},{"id":26662554,"identity":"711c6eb8-f86b-4588-b831-cf53939cfd50","order_by":2,"name":"Huong Minh","email":"","orcid":"","institution":"Charité-Universitätsmedizin Berlin","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Huong","middleName":"","lastName":"Minh","suffix":""},{"id":26662555,"identity":"3046380e-79ba-477a-8c3d-d658981a4c27","order_by":3,"name":"Jonas Massmann","email":"","orcid":"","institution":"Charité-Universitätsmedizin Berlin","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jonas","middleName":"","lastName":"Massmann","suffix":""}],"badges":[],"createdAt":"2021-05-11 13:32:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-515087/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-515087/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13630991,"identity":"02c62e48-96a8-4f49-a724-8056766daf3b","added_by":"auto","created_at":"2021-09-17 08:14:49","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":832579,"visible":true,"origin":"","legend":"Article File","description":"","filename":"20210511CortBSWIPANOmanuscriptfinal.pdf","url":"https://assets-eu.researchsquare.com/files/rs-515087/v1_covered.pdf"},{"id":9106005,"identity":"1b706863-7874-4ce6-8004-495cef2c3474","added_by":"auto","created_at":"2021-05-12 20:25:20","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":828996,"visible":true,"origin":"","legend":"Article File","description":"","filename":"20210511CortBSWIPANOmanuscriptfinal.pdf","url":"https://assets-eu.researchsquare.com/files/rs-515087/v1_covered.pdf"},{"id":9106004,"identity":"b7fe133c-116a-4ea4-a610-381180a75bad","added_by":"auto","created_at":"2021-05-12 20:25:14","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":217220,"visible":true,"origin":"","legend":"Supplementary Materials","description":"","filename":"Supplementarymaterialsformanuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-515087/v1/e64c27f9e4b4b442aeb428ed.pdf"}],"financialInterests":"\u003cb\u003eYes\u003c/b\u003e there is potential Competing Interest.\nJM is employee of poroUS GmbH, a startup developing the CortBS technology. 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The established diagnosis is based on the measurement of areal bone mineral density by dual energy x-ray absorptiometry (DXA), which poorly captures individual bone loss and structural decay. Enlarged cortical pores in the tibia have been proposed to indicate structural deterioration and reduced bone strength in the hip. Here, we report for the first time the in-vivo assessment of the cortical pore size distribution together with viscoelastic bone properties by means of a novel ultrasonic cortical backscatter (CortBS) technology to discriminate between fractured and nonfractured postmenopausal women (N = 55). The discrimination performance was benchmarked with DXA and high-resolution peripheral computed tomography (HR-pQCT). 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