Bone Strain Index

Although bone density (BMD) is considered a good indicator of bone strength, many fractures occur with mild osteopenia or within the normal range. In order to better evaluate the fracture risk, it is therefore necessary to consider other parameters, clinical and densitometric, which influence bone strength.

Bone Strain Index is a Medical Device Software that provides information on bone stress and deformation according to the specific patient.

Although it has been known for a long time that the phenomena of fracture and bone remodeling are driven by deformation, the role of the latter in the specific clinical context is still the subject of research.

In this regard, various collaborations are active to refine the calculations underlying the software and improve their clinical interpretation according to the specific application.

The Bone Strain Index software combines the automatic calculation of strain on the femur and lumbar spine based on Finite Element Models, a useful interface for data classification and basic statistics.

Bone Strain Index

List of publications

Ulivieri FM, Rinaudo L, Messina C, Aliprandi A, Sconfienza LM, Sardanelli F, Cesana BM. Bone Strain Index: preliminary distributional characteristics in a population of women with normal bone mass, osteopenia and osteoporosis. Radiol med (2022).

Cuttone S, Rinaudo L, Bignardi C, Aldieri A, Terzini M, Croce A, Messina C, Mangiavini L, Sconfienza LM, Ulivieri FM. DXA-Based Finite Element Analysis as Support for Pre and Post-operative Evaluation of Hip Arthroplasty. J. Med. Biol. Eng. (2022).

Ulivieri FM, Rinaudo L. The Bone Strain Index: An Innovative Dual X-ray Absorptiometry Bone Strength Index and Its Helpfulness in Clinical Medicine. J Clin Med. 2022;11(9):2284. Published 2022 Apr 20.

Sornay-Rendu E, Duboeuf F, Ulivieri FM, Rinaudo L, Chapurlat R. The bone strain index predicts fragility fractures. The OFELY study. Bone. 2022 Feb 1;157:116348. doi: 10.1016/j.bone.2022.116348. Epub ahead of print. PMID: 35121211.

Ulivieri FM, Rinaudo L, Messina C, Piodi LP, Capra D, Lupi B, Meneguzzo C, Sconfienza LM, Sardanelli F, Giustina A, Grossi E. Bone Strain Index predicts fragility fracture in osteoporotic women: an artificial intelligence-based study. Eur Radiol Exp. 2021 Oct 19;5(1):47. doi: 10.1186/s41747-021-00242-0. PMID: 34664136.

Buccino, F., Colombo, C., Duarte, D.H.L. et al. 2D and 3D numerical models to evaluate trabecular bone damage. Med Biol Eng Comput 59, 2139–2152 (2021).

Tabacco G, Naciu AM, Messina C, Sanson G, Rinaudo L, Cesareo R, Falcone S, Manfrini S, Napoli N, Bilezikian JP, Ulivieri FM, Palermo A. DXA-Based Bone Strain Index: A New Tool to Evaluate Bone Quality in Primary Hyperparathyroidism. J Clin Endocrinol Metab. 2021 Jul 13;106(8):2304-2312.
doi: 10.1210/clinem/dgab317

Ulivieri FM, Rinaudo L, Piodi LP, Messina C, Sconfienza LM, Sardanelli F, et al. Bone strain index as a predictor of further vertebral fracture in osteoporotic women: An artificial intelligence-based analysis. PLoS ONE 16(2): e0245967 (2021).

Ulivieri FM, Rinaudo L. Beyond Bone Mineral Density: A New Dual X-Ray Absorptiometry Index of Bone Strength to Predict Fragility Fractures, the Bone Strain Index, Frontiers in Medicine (2021).

Messina C, Acquasanta M, Rinaudo L, Tortora S, Arena G, Albano D, Sconfienza LM, Ulivieri FM. Short-Term Precision Error of Bone Strain Index, a New DXA-Based Finite Element Analysis Software for Assessing Hip Strength, Journal of Clinical Densitometry (2020).

Messina, C., Rinaudo, L., Cesana, B.M. et al. Prediction of osteoporotic fragility re-fracture with lumbar spine DXA-based derived bone strain index: a multicenter validation study. Osteoporos Int (2020).

Ulivieri, F.M., Rinaudo, L., Piodi, L.P. et al. Usefulness of Dual X-ray Absorptiometry-Derived Bone Geometry and Structural Indexes in Mastocytosis. Calcif Tissue Int (2020).

Ulivieri, F.M., Piodi, L.P., Rinaudo, L. et al. Bone Strain Index In The Prediction Of Vertebral Fragility RefractureEur Radiol Exp 4, 23 (2020) doi:10.1186/s41747-020-00151-8

Messina C, Piodi LP et al. (2020) Artificial neural network analysis of bone quality DXA parameters response to teriparatide in fractured osteoporotic patients. PLoS One. doi:

Messina C, Piodi LP, Rinaudo L, Buonenna C, Sconfienza LM, Vergani L, Ulivieri FM (2020) Reproducibility of DXA-based bone strain index and the influence of body mass: an in vivo study. Radiol med 125, 313-318

Messina C, Piodi LP, Rinaudo L, Emili I, Porro F, Buonenna C, Sconfienza LM, Vergani L, Ulivieri FM (2019) Bone strain index reproducibility and soft tissue thickness influence: a dual x-ray photon absorptiometry phantom study. European Radiology Experimental 3:33 doi:10.1186/s41747-019-0110-9

Terzini M, Aldieri A, Rinaudo L, Osella G, Audenino AL and Bignardi C (2019) Improving the Hip Fracture Risk Prediction Through 2D Finite Element Models From DXA Images: Validation Against 3D Models. Front. Bioeng. Biotechnol. 7:220. doi: 10.3389/fbioe.2019.00220

Colombo C, Libonati F, Rinaudo L, Bellazzi M, Ulivieri FM, Vergani L (2019) A new finite element based parameter to predict bone fracture. PLoS ONE 14(12): e0225905. doi:10.1371/journal.pone.0225905

Rodari G, Scuvera G, Ulivieri FM, et al (2018) Progressive bone impairment with age and pubertal development in neurofibromatosis type I. Arch Osteoporos 13:93.

Ulivieri FM, Rebagliati GAA, Piodi LP, et al (2018) Usefulness of bone microarchitectural and geometric DXA-derived parameters in haemophilic patients. Haemophilia.

Ulivieri FM, Piodi LP, Grossi E, et al (2018) The role of carboxy-terminal cross-linking telopeptide of type I collagen, dual x-ray absorptiometry bone strain and Romberg test in a new osteoporotic fracture risk evaluation: A proposal from an observational study. PLoS One 13:e0190477. 



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