Journal of Medical and Biological Engineering, 26(1): 1-7 1 Effects of Bone Mineral Fraction and Volume Fraction on the Mechanical Properties of Cortical Bone James Shih-Shyn Wu Hsiao-Che Lin Jui-Pin Hung1 Jian-Horng Chen2,* Institute of Mechanical Engineering, National Chung-Hsing University, Taichung, Taiwan, 402 ROC Department of Mechanical Engineering, National Chin-Yi Institute of Technology, Taichung, Taiwan, 401 ROC 2 Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan, 402 ROC 1 Received 29 Aug 2005; Accepted 7 Nov 2005 Abstract This study evaluated how bone mineral fraction and volume fraction influence bovine cortical bone strength. Dual energy X-ray absorptiometry (DEXA) was applied to determine the mineral content of each bovine cortical specimen. The water displacement method was applied to measure pore volume and, accordingly, calculate porosity and bone mineral fraction. Additionally, the mechanical properties of specimens were obtained with a material test system (MTS). This study derives three two-parameter power law functions for Young’s modulus, toughness and the ultimate strength of wet cortical bone. Analytical results indicate that the change in volume fraction exerts a stronger influence on the biomechanical properties of the cortical bone than on those of the bone mineral fraction. Results of this study provide a valuable reference for biomechanical research or as reference data for clinical diagnosis. Keywords: Bone mineral fraction, Bone volume fraction, Porosity, Biomechanical property, Young's modulus Introduction Osteoporosis is a serious public health problem for women in midlife, and progresses with age. Osteoporosis symptoms include both low bone mass and microarchitectural changes in bone tissue, which raise susceptibility to bone fractures from minor traumas [1]. Reduced bone mineral density (BMD) appears to be a major determinant of bone fragility [2-4]. Assessment of cortical bone according to mechanical properties is relevant for predicting fracture risk and the selection of suitable therapeutic strategies for orthopaedic surgery or rehabilitation [5-7]. Relevant literature indicates that the mechanical properties of bones are primarily determined by their mineral content [8-10]. Carter and Hayes showed that the Young’s modulus of trabecular and cortical bone were directly proportional to the cube of the apparent wet density [11]. Schaffler and Burr discovered that Young’s modulus of bovine cortical bone is directly proportional to the apparent density raised to the power of 7.4 [12]. Keller et al. reported that the bending Young's modulus of human compact bone is directly proportional to the dry apparent density raised to the power of 1.54 [13]. Wachter et al. [14] in 2002 indicated strong correlation between cortical bone mineral density and mechanical strength. Not only were the strength and stiffness of cortical bone * Corresponding author: Jian-Horng Chen Tel: +886-4-24730022 ext. 11764; Fax: + 886-4-23248176 E-mail: jhchen@csmu.edu.tw proportional to the bone mineral density [15-17], but the porosity was also noted as an important factor influencing skeleton strength [18, 19]. The cortical structure contains Haversian canals, vascular canals and lacunae, which are generalized as pores or cavities of the cortex. Porosity (P) is defined as pore volume ( V P ) per unit whole/total volume ( VT ) [20]. Schaffler found that the elastic modulus of bovine cortical bone fell as the power (-0.55) of porosity increased in the tensile test [12]. Carter and Hayes in 1976 [21] derived the equation of the Young’s modulus, E = kV f3 , from cancellous bone and compact bone, where V f represents the volume fraction. Currey [22] obtained a strong relationship between Young’s modulus and both calcium content and volume fraction. Bell et al. [23] pointed out that increased porosity and higher prevalence of giant canals both have a significantly negative influence on the ability of the cortical shell to withstand stress. As mentioned above, previous studies discussed the bone mineral content or porosity with Young’s modulus either individually or combined as bone density. However, Hernandez et al. [24] found that the bone volume fraction (i.e. 1 minus the porosity) and mineral fraction were poorly correlated ( r 2 = 0.01 ), suggesting the two are independent parameters. The variation of bone mineral fraction and bone volume fraction may differ during bone changes. Additionally, the bone mineral fraction in bone can be considered to represent “bone quality”, while bone volume represents “bone quantity”, which are two independent variables. This study J. Med. Biol. Eng., Vol. 26. No. 1 2006 2 Femoral Shaft Axis Compression Plate Screw for Fastening on Upper Crosshead Cortical Specimen Basin Midline Screw for Fastening on Machine Platform Cortical Specimen Medial Lateral Figure 1. Cortical specimen of bovine femur. thus evaluates how bone volume fraction and bone mineral fraction affect bovine cortical bone strength. Three two-parameter power law functions for the mechanical properties of wet cortical bone were derived. Materials and Methods Specimen preparation Twenty-nine 2–3-year-old bovine femoral bones were adopted in this study. The femoral diaphysis of each bone was extracted and the fibrous periosteum removed. It was then maintained at −20 °C for further manipulation. Only one cylindrical specimen was extracted from each femur at the medial part, and its axis was parallel to the femoral shaft axis (Fig. 1). Dong and Guo [25] in 2004 proved that longitudinal Young’s modulus has a significantly negative relationship with cortical bone porosity, while no such relationship exists between transverse Young’s modulus and porosity. Since the thickness of the cortical shell was capricious among different femurs, specimens were machined to a diameter of 7.28 ± 0.80 mm and a length of 12.50 ± 0.21 mm by a water-cooled diamond lathe and a milling machine. The bone specimens were irrigated during manipulation with ringer’s lactate to prevent drying and overheating [13]. The total volume VT of each specimen can be computed from 1 VT = D 2πL , where D and L represent the diameter and 4 length, respectively. Measurement of bone mineral content DEXA scans were performed on each specimen with the EXPERT-XL system (LUNAR) to obtain bone mineral content ( WM ). To simulate an in vivo setting, each specimen was immersed in water to a depth of 10 cm [26], which has been shown to accurately simulate the surrounding soft tissue [27]. To investigate whether the bone mineral content relates to the scan direction, a longer bone slice was chosen, and applied the x-ray beam parallel followed by the perpendicular to the femoral shaft axis. This simple experiment proves that the measured bone mineral content is unrelated to the scan direction. Figure 2. Compression apparatus. Measurement of dry and wet weights All cortical specimens were thoroughly defatted in full-strength chloroform [28] and placed in an incubator (YIH DER LE-549) at 50 °C for 72 hours to dry to a constant weight (<0.05% change) to remove excess fluid. The moisture of the specimen was thoroughly evaporated to leave only the solid frame. As each specimen was taken from the incubator, its dry weight ( WD , solid frame weight) was immediately measured by an analytical balance (Mettler AE240-S), which can measure weights to 0.0001 g. The bone water content of slice was assumed to be 0 g at this point. According to the porous media theory [29], porous structures are composed of a ‘solid skeleton’ and ‘interstitial fluid’, in which the voids of the solid skeleton are saturated with fluid [30]. Thus, if specimens are sufficiently soaked, the fluid content can be used to estimate the void volume. Pilot studies performed in our laboratory found that the specimen weight was almost unchanged after 2 days (2880 min) of soaking. All specimens were soaked with distilled water for 2.5 days (3600 min) to reach at least 99% saturation, where 99% of the cortical pores are occupied by fluid. The surface water was then gently wiped off the specimens, which were then weighed ( WW ). Calculation of bone volume fraction and mineral fraction For each saturated specimen, the void spaces were filled with W f g of distilled water. The void volume ( VP ) was then calculated by the formula VP = W f 0.9971 , where 0.9971 is the density of distilled water, and W f = WW − WD . The porosity P was calculated by the formula P = V P VT , and the bone volume fraction α = 1 − P . Dividing mineral content WM by the solid bone mass WD yields the bone mineral fraction γ . Measurement of the Young’s modulus, Ultimate Stress and Toughness The mechanical tests were performed by the Chung Shan Institute of Science and Technology, Ministry of Defense, Taiwan. A custom-made compression apparatus was adopted (Fig. 2), which included a basin and a compression plate. The basin with a screw at the bottom center and the compression plate with a screw at the upper center were machined from a round iron bar. Both components were formed in one piece and fastened onto the apparatus platform with a screw thread to prevent any error resulting from gap and buckling. The cortical Mechanical Properties of Bone 3 specimen was erected at the center of the basin. The centers of the specimen, basin and compression plate were all aligned with the central screw axis. The specimens were loaded at a crosshead rate of 0.5mm/min to minimize non-linear effects. The compression test results were plotted as stress-strain curves and applied to calculate the mechanical compression properties. Numerical analysis Assume that the two-parameter function is given by: Y = Kα a γ b (1) where K, a and b represent undetermined variables; α represents the bone volume fraction, γ represents the mineral fraction, and Y represents either Young’s modulus, ultimate strength, or toughness. Taking the logarithms for Eq. (1) at two sides yields: ln Y = ln K + a ln α + b ln γ (2) Figure 3. Stress-strain curve of the compression test, indicating how Young’s modulus, ultimate stress, and toughness is obtained. Table 1. Experimental data of the twenty nine cortical specimens. Given ln Y = Y , ln K = K , ln α = α , and ln γ = γ , Eq. (2) could be expressed as: Y = K + aα + bγ (3) Given a set of experimental data with (α i , γ i , Yi ) , i = 1 to N, the data were first modified to (α i , γ i , Yi ) by taking the logarithms. Assuming that the predicted value Yi ′ satisfies Yi ′ = K + aα i + bγ i , the following method for selecting ( K , a, b) was proposed to minimize e ( K , a , b) = 1 N 1 = N Young’s Modulus E (GPa) 0.846 0.882 0.866 0.010 0.611 0.685 0.650 0.023 10.10 15.55 12.59 1.26 N ∑ ( K + aα i + bγ i − Yi ) 2 i =1 (5) We have: ∂e = ∑ 2(Yi − K − aα i − bγ i )(−1) = 0 ∂K (6) ∂e = ∑ 2(Yi − K − aα i − bγ i )(−α i ) = 0 ∂a (7) ∂e = ∑ 2(Yi − K − aα i − bγ i )(−γ i ) = 0 ∂b (8) Arranging Eq. (6) to Eq. (8) yields: ∑α i ∑γ i 2 ∑ α i ∑ α iγ i 2 ∑ α iγ i ∑ γ i Ultimate Stress σ ult Toughness (MPa) (MPa) 140.11 185.05 161.90 16.84 0.97 1.51 1.22 0.16 * Standard Deviation Results (4) i =1 ∂ ∂ ∂ , , ) e (K , a , b ) = 0 ∂ K ∂a ∂b K ∑1 a = ∑ α i b ∑γ i Mineral Fraction γ (-) N ∑ (Yi ′ − Yi ) 2 where e( K , a, b) denotes a function with three variables K , a and b, and its minimum occurs at ( K , a, b) , as: ( Minimum Maximum Mean S.D.* Volume Fraction α (-) −1 ∑ Yi ∑ Yiα i ∑Y γ i i (9) Equation (9) could be solved directly, yielding the variables a, b, and K = e K . Figure 3 shows the stress-strain curve of compression test. All specimens show similar tending graphs, and all have a long straight portion in the curves. The slope of the straight portion in the curve is the Young’s modulus E (GPa). The toughness is obtained by computing the area underneath the stress-strain curve from zero stress to peak stress. Since the strain is dimensionless, the unit for toughness is given by MPa. Toughness measures the amount of energy that a sample can absorb before breaking. Additionally, the ultimate stress σ ult (MPa) denotes the maximum stress before breaking. Table 1 shows 29 experimental data sets obtained from several measurements and compression tests. The Young’s modulus, ultimate stress and toughness values outside the range of Mean ± 2SD were excluded, and the remainders were then substituted into Eq. (9), yielding three equations: E = 20.80α 2.55γ 0.33 (10) σ ult = 221.72α 3.70 γ −0.50 (11) Toughness = 1.20α 1.95γ −0.68 (12) Using Eq. (10)-(12), Table 2 shows the changes of value for E, σ ult and the toughness as the value for bone volume fraction α and bone mineral fraction γ fluctuates. The proportions of mechanical properties change when the values of α and γ increase or decrease by 5%. J. Med. Biol. Eng., Vol. 26. No. 1 2006 4 Table 2. Changes of value for E, σ ult and toughness as the value for α and γ fluctuate Change (%) Volume Fraction α +5 % -5 % Mineral Fraction γ +5 % -5 % E +13.25 % -12.26 % +1.62 % -1.68 % σ ult +19.78 % -17.29 % -2.41 % +2.60 % -3.26 % +3.55 % Toughness +9.98 % -9.52 % (a) (b) (c) Figure 4. Plots of curved surface equations: (a) Young’s modulus E, (b) Ultimate stress σ ult , (c) Toughness. Discussion Bone is a composite material consisting of an organic phase synthesized by osteoblasts and an inorganic phase composed primarily of calcium phosphate crystallized as a nonstoichiometric apatite. The poroelastic solid theory, proposed by Biot [29], is a solid-liquid biphasic structure modeled as a deformable porous solid matrix filled with saturated fluid. The porosity is defined as the percentage of the fluid volume to bulk volume. Wang and Feng [31] in 2005 applied composite material theory to show that the mineral phase is designed to sustain the forces on the bones, and that it contributes to the bone’s mechanical properties such as stiffness and strength. Decreasing the bone mineral content not only reduces the bone stiffness, but also raises the risk of bone fracture from falling. Minerals account for 60% to 70% of the dry weight of normal human bone [32]. The mineral fraction ranges from 0 (osteoid) to 0.7 (fully mineralized bone), which is calculated as the mineral content divided by dry weight [24]. Specimens were obtained for this study from bovine cortical bones, with a volume fraction α (defined as the bone solid volume divided by the total volume) ranging from approximately 84.6% to 88.2%, and the bone mineral fraction γ from 61.1% to 68.5% (Table 1). Both bone volume fraction and bone mineral fraction significantly affect the bone’s biomechanical properties [8-12, 14, 23], and neither should be neglected. This study differs from others in that it applies a two-parameter model to describe the mechanical properties of cortical bone. Equations (10)-(12) reveals that the Young’s modulus, ultimate stress and toughness are influenced by these two variable parameters α and γ . Figure 4 shows a 3D curve surface of these three equations. As indicated in Fig. 4(a), the value of E rises with an increasing of bone volume fraction α or bone mineral fraction γ . The Young’s modulus is thus positively related to α and γ . Figures 4(b) and (c) show that ultimate stress and toughness are also positively related to volume fraction α, while inversely related to bone mineral fraction γ. Table 2 lists the levels of influence exerted on Young’s modulus, ultimate stress and toughness by α and γ . The Young’s modulus, E, changes in the same direction as changes in α and γ . When α increases by 5%, E rises by 13.25%. If α decreases by 5%, then E falls by 12.26%. Conversely, when γ increases by 5%, E only rises by 1.62%. When γ decreases by 5%, E falls by 1.68%. The relationship of the bone volume fraction with Young’s modulus is more significant and important than its relationship with the mineral fraction γ. As regards ultimate stress, when α increases by 5%, ultimate stress rises significantly by 19.78%. However, when γ increases by 5%, ultimate stress falls by 2.41%. Thus α has a stronger effect on ultimate stress than γ , and α and ultimate stress are positively related. Conversely, γ shows a small inverse effect on ultimate stress. Toughness is found by calculating the total area under the stress-strain curve from zero stress up to maximum stress. When α increases by 5%, toughness rises by 9.98%. However, when γ increases by 5%, toughness falls by 3.26%. Thus α also has a stronger effect on toughness than γ , and α and toughness are also positively related. When both bony matrix volume and mineral content rise, in other words, when bone mineral density increases, the mechanical properties of the whole unit still tend to strengthen. Mechanical Properties of Bone Table 3: 5 Comparison of literature regarding relations between Young’s modulus and volume fraction ( α ) and ash fraction ( γ ). Source Loading condition Material compression Currey [22] Schaffler and Burr [12]* Hernandez et al. [24] Current study Young’s modulus exponent volume fraction ( α ) mineral fraction ( γ ) cortical and cancellous 2.58±0.022 2.74±0.129 tension cortical 3.52 3.17 tension cortical 10.92 3.91 compression cortical 2.55 0.33 * Equation based on individual one-parameter model. As stated above, the solid skeleton in bone tissue consists of an organic and inorganic phase. The inorganic component of bone makes the tissue hard and rigid, whereas organic components account for the flexibility and resilience of the bone [32]. That is, if the total weight of a solid skeleton is fixed, increasing the mineral fraction of bone decreases the flexibility of bone tissue, strain and elongation. Toughness, the area under the stress-strain curve, is thus decreased. Several studies have only investigated the relationship between Young’s modulus and bone components [12, 22, 24]. Documents concerning the quantitative effects of bone mineral fraction and bone volume fraction on toughness or ultimate stress have not been found. In this study, the measured bone volume fraction, bone mineral fraction, and Young’s modulus are all within the ranges found in the literature [24, 32]. Thus, the obtained toughness and ultimate stresses in this study are reliable. Generally, increasing bone mineral content improves the mechanical properties of bone; however, that may be due to an increase in the mineral content, the total volume of solid skeleton increases in the meantime, and thus the porosity of the cortical bone decreases. This study showed that bone volume fraction has a stronger positive effect on mechanical properties than bone mineral fraction. This analytical result is also consistent with those obtained by previous studies [12, 22]. Table 2 indicates that when bone volume fraction is fixed, the changes of the value for E, σ ult and the toughness as the value for bone mineral fraction fluctuates by itself. Notably, the specimens used in this study were harvested from 2– to 3–year-old bovine femurs. The analytical results of this study cannot be extended to newborns or premature subjects. Schaffler and Burr [12] drew the same conclusions from their experiment, indicating that mineralization directly influences cortical bone stiffness, and Young’s modulus of cortical bone is more highly related to volume fraction. Power law models based on bone volume fraction and mineral fraction have also been applied in previous studies (Table 3). Hernandez et al. [24] used specimens from human bones for the compression tests. The volume fraction in their study was obtained from a derived expression for bone volume fraction as a function of tissue density, rather than from direct measurements. The specimens adopted in his experiments included cortical bones and cancellous bones, with volume fraction ranging from 2.2% to 84.3%. While Currey [22] performed his tension tests with cortical bone specimens obtained from different animal species. The γ parameter in his study denoted the calcium content, not the mineral fraction. Schaffler and Burr [12] obtained their bone specimens from 2–3-year-old cattle, with volume fractions ranging from 92.2% to 97.1%, clearly well above the normal value found in other bovine bones normally applied for experiments. Furthermore, because Young’s modulus was discussed separately from volume fraction and mineral fraction, a larger exponent related to bone volume fraction might have been reported. The cortical bone specimens applied for compression tests in this study were obtained from 2–3-year-old adult bovine, with a volume fraction ranging from 84.6% to 88.2%. Since different specimens resulted in a different volume fraction range, the obtained exponent values were not consistent. Schaffler and Burr [12] found that cortical bone and cancellous bone are made of the same materials, but with different structures and significant differences in volume fractions, and different mechanical properties, and hence cannot be properly described by a single mathematical model. Hernandez et al.’s experimental results [24] indicate that the mineral fraction has a stronger effect than the volume fraction on Young’s modulus. This finding is different from those from other studies, possibly because Hernandez et al. adopted specimens including both bones and cancellous bones with a wide volume fraction range. A review of the experiments results in Table 3, and excluding Hernandez’s findings, indicates that all other data show some differences, but all consistently reveal that the volume fraction exponent is typically larger than the mineral fraction exponent, suggesting that the relationship between Young’s modulus and the volume fraction is more significant than the mineral fraction. Day et al. [33] found that when bisphosphonates were applied to treat osteoporosis in dogs, the bone mineral density rose significantly increased during the first year of treatment, and rose more slowly thereafter. The initial BMD gain is due to the increase in total bone volume (when the bone remodeling space was filled in), while the later BMD gain is a result of increased mineralization. Day et al. [33] also observed that the increase in Young’s modulus was caused by increased bone mass and altered trabecular architecture, rather than changes in the calcified matrix. This finding is consistent with the results of this study, suggesting that the Young’s modulus correlates more strongly with the volume fraction than with the mineral fraction. This study has a few limitations. First, human bone specimens are hard to obtain, so bovine cortical bones were J. Med. Biol. Eng., Vol. 26. No. 1 2006 6 adopted instead. Should an opportunity occur in the future, we shall consider using human bones for the experiments in order to obtain more comprehensive data. Second, only compression tests were performed. If tension and bending tests could be carried out on specimens from different parts of the bone with different orientations, then more human bodily movements could be simulated in various positions, thus obtaining more practical and precise data than could be obtained in this study. Third, the specimens used in this experiment were all obtained from healthy normal cattle, with similar bone structures and mechanical properties. Future work may investigate bone resorption phenomena and identify changes to the mechanical properties that occur in response to some disease states, such as osteoporosis and abnormal hormone levels, with the aim of developing diet programs or medicines that could help patients restore their BMD and increase the mechanical strength of bones. Conclusion The percentage of the solid materials content in cortical bone has a much more significant effect than mineral content on the mechanical properties of bone, such as Young’s modulus, ultimate stress and toughness. This investigation further found that volume fraction is positively related to all these three mechanical properties, and it is the most important factor among those studied. Conversely, the mineral fraction is inversely related to ultimate stress and toughness, and has a smaller effect than the volume fraction. When both bony solid matrix volume and mineral content rise, that is, when the bone density increases, the mechanical properties of the whole unit still tend to strengthen. The cortical bone mechanical properties, Young’s modulus, ultimate stress, and toughness, which are required parameters for biomechanical calculations, could easily be predicted from the equations derived in this study, together with the volume and mineral fractions. Acknowledgement The authors would like to thank Chung Shan Medical University for financially supporting this research under Contract No. CSMU92-OM-B-036. [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] References [1] [2] [3] [4] E. Legrand, D. Chappard, C Pascaretti, M. Duquenne, S. Krebs, V. Rohmer, M. F. Basle, M. Audran, “Trabecular bone microarchitecture, bone mineral density, and vertebral fractures in male osteoporosis,” J. Bone Miner. Res., 15: 13-19, 2000. S. R. Cummings, M. C. Nevitt, W. S. Browner, el al., “Risk factors for hip fracture in white women,” N. Engl. J. med., 332: 767-773, 1995. S. R. Cummings, D. M. Black, M. C. Nevitt, et al., “Bone density at various sites for prediction of hip fractures: the study of osteoporotic fractures,” The Lancet, 341: 72-75, 1993. A. C. Courtney, E. F. Wachtel, E. R. Myers, W. C. Hayes, “Age-related reductions in the strength of the femur tested in a fall-loading configuration,” J. Bone Jt. Surg., Am., 77: 387-395, 1995. [23] [24] [25] [26] [27] C. Werner, B. F. Iversen, M. H. Therkildsen, “Contribution of the trabecular component to mechanical strength and bone mineral content of the femoral neck: an experimental study on cadaver bones,” Scand. J. Clin. Lab. Invest., 48: 457-460, 1988. J. C. Lotz, E. J. Cheal, W. C. Hayes, “Stress distributions within the proximal femur during gait and falls: implications for osteoporotic fractures,” Osteoporosis International, 5: 252-261, 1995. J. L. Ferretti, H. M. Frost, J. A. Gasser, et al., “Perspectives on osteoporosis research: its focus and some insights from a new paradigm,” Calcif. Tissue Int., 57: 399-404, 1995. R. B. Martin, “Determinants of the mechanical properties of bone,” J. Biomech., 24: 79-88, 1991. J .Moreno, F. Forriol, “Effects of preservation on the mechanical strength and chemical composition of cortical bone: an experimental study in sheep femora,” Biomaterials, 23: 2615-2619, 2002. J. D. Currey, “The effect of strain rate, reconstruction and mineral content on some mechanical properties of bovine bone,” J. Biomech., 8: 81-86, 1975. D. R. Carter, W. C. Hayes, “The compressive behaviour of bone as a two-phase porous material,” J. Bone Jt. Surg., 59A: 954-962, 1977. M. B. Schaffler, D. B. Burr, “Stiffness of compact bone: Effects of porosity and density,” J. Biomech., 21: 13-16, 1988. T. S. Keller, Z. Mao, D. M. Spengler, “Young's modulus, bending strength, and tissue physical properties of human compact bone,” J. Orthop. Res., 8(4): 592-603, 1990. N. J. Wachter, G. D. Krischak, M. Mentzel, et al., “Correlation of bone mineral density with strength and microstructural parameters of cortical bone in vitro”, Bone, 31(1): 90-95, 2002. D. R. Carter, W. C. Hayes, D. J. Schurman, “Fatigue life of compact bone-II. Effect of microstructure and density,” J. Biomech., 9: 211-218, 1976. J. D. Curry, K. Brear, P. Zioupos, “The effect of ageing and changes in mineral content in degrading the toughness of human femora”, J. Biomech., 29: 257-260, 1996. Y. N. Yeni, C. U. Brown, T. L. Norman, “Influence of bone composition and apparent density on fracture toughness of the human femur and tibia,” Bone, 22: 79-84, 1998. R. P. Dickenson, W. C. Hutton, J. R. R. Stott, “The mechanical properties of bone in osteoporosis,” J. Bone Jt. Surg., Br., 63: 233-238, 1981. J. C. Wall, S. K. Chatterji, J. W. Jeffery, “Age-related changes in bone density and tensile strength of human femoral cortical bone,” Calcif. Tissue Int., 27: 105-108, 1979. R. B. Martin, “Porosity and specific surface of bone,” Crit. Rev. Biomed. Eng., 10: 179-222, 1984. D. R. Carter, W. C. Hayes, “Bone compressive strength : the influence of density and strain rate,” Science, 194: 1174-1176, 1976. J. D. Currey, “The effect of porosity and mineral content on the Young’s modulus of elasticity of compact bone,” J. Biomech., 21(2): 131-139, 1988. K. L. Bell, N. Loveridge, J. Power, N. Garrahan, B. F. Meggitt, J. Reeve, “Regional differences in cortical porosity in the fractured femoral neck,” Bone, 24(1): 57-64, 1999. C. J. Hernandez, G. S. Beaupre, T. S. Keller, D. R. Carter, “The influence of bone volume fraction and ash fraction on bone strength and modulus,” Bone, 29: 74-78, 2001. X. N. Dong, X. E. Guo, “The dependence of transversely isotropic elasticity of human femoral cortical bone on porosity,” J. Biomech., 37: 1281-1287, 2004. G. A. Lundeen, S. L. Knecht, E. G. Vajda, R. D. Bloebaum, A. A. Hofmann, “The contribution of cortical and cancellous bone to dual-energy X-ray absorptiometry measurements in the female proximal femur,” Osteoporosis International, 12: 192-198, 2001. D. Sartoris, F. Sommer, R. Marcus, P. Madvig, “Bone mineral Mechanical Properties of Bone [28] [29] [30] density in the femoral neck: quantitative assessment using dual energy projection radiography,” Am. J. Roentgenol., 144: 605-611, 1985. J. G. Skedros, R. D. Bloebaum, M. W. Mason, D. M. Bramble, “Analysis of a tension/compression skeletal system: possible strain-specific differences in the hierarchical organization of bone,” Anat. Rec., 239: 396-404, 1994. M. A. Biot, “General theory of three-dimensional consolidation,” J. Appl. Physi., 12: 155-164, 1941. J. S. S. Wu, J. H. Chen, “Clarification of the mechanical behaviour of spinal motion segments through a three-dimensional poroelastic mixed finite element model,” Med. Eng. Physics, 18(3): 215-224, 1996. [31] [32] [33] 7 T. Wang, Z. Feng, “Dynamic mechanical properties of cortical bone: The effect of mineral content,” Mater. Lett., 59: 2277-2280, 2005. M. Nordin, V. H. Frankel, Basic Biomechanics of the Musculoskeletal System. Maryland, USA: Lippincott Williams & Wilkins, 3ed., Ch.2: 27-55, 2001. J. S. Day, M. Ding, P. Bednarz, J. C. van der Linden, T. Mashiba, T. Hirano, C. C. Johnston, D. B. Burr, I. Hvid, D. R. Sumner, H. Weinans, “Bisphosphonate treatment affects trabecular bone apparent modulus through micro-architecture rather than matrix properties,” J. Orthop. Res, 22: 465-471, 2004.