In vivo mechanical assessment of cortical bone rigidity enhances fracture discrimination beyond DXA in postmenopausal women
Authors' conclusion
Biomechanical assessment of bone rigidity provides clinically relevant information beyond areal BMD, including women not classified high risk.
Study context
- Population
- Postmenopausal women aged 50–80 yr, 4 US sites
- Participants
- 372 women
- Comparison
- Ulna flexural rigidity (EI) by cortical bone mechanics technology (CBMT) vs DXA-derived BMD for discriminating prior fragility fractures
- Fracturen = 109
- Controlsn = 263reference
- Outcome
- Ulna EI
Methodological detailsmulticenter, cross-sectional exposure assessment, matched controls
- Multicenter
- Cross-sectional exposure assessment
- Matched controls
Main finding
As reported in the abstract
Absolute EI, % lower
21%
P < 0.001
Fracture
Weight-normalized EI, % lower
22%
P < 0.001
Fracture
Observational data: associations, not effects.
Further findings
Discrimination of prior fracture (AUC)
- CBMT AUC, normalized
- 0.80
- CBMT AUC, absolute
- 0.76
- DXA AUC (fair to poor); CBMT AUCs significantly better
- ≤ 0.63
Multivariable models with CBMT and DXA BMD
- CBMT remained independently associated with fracture status, whereas BMD did not
CBMT AUC in subgroups
- Treatment-naïve women
- 0.85
- Non-osteoporotic BMD
- 0.80
Fracture-site analyses
- Ulna EI discriminated upper and lower extremity fractures, including hip, whereas DXA BMD generally showed fair to poor discrimination
- Exploratory
Original publication
In vivo mechanical assessment of cortical bone rigidity enhances fracture discrimination beyond DXA in postmenopausal women. J Bone Miner Res. Published 16 February 2026. doi:10.
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