<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">ABB</journal-id><journal-title-group><journal-title>Advances in Bioscience and Biotechnology</journal-title></journal-title-group><issn pub-type="epub">2156-8456</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/abb.2013.44069</article-id><article-id pub-id-type="publisher-id">ABB-29893</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biomedical&amp;Life Sciences</subject></subj-group></article-categories><title-group><article-title>
 
 
  Is osteoporosis systemic?
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>onald</surname><given-names>L. Huston</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kenneth</surname><given-names>L. Weiss</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Rutvij</surname><given-names>Kotecha</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mina</surname><given-names>Dimov</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib></contrib-group><aff id="aff1"><addr-line>School of Dynamic Systems, University of Cincinnati, Cincinnati, USA</addr-line></aff><aff id="aff2"><addr-line>Neuroimaging Research and Radiology, University of Mississippi Medical Center, Jackson, USA</addr-line></aff><aff id="aff3"><addr-line>Material Science and Engineering, University of Cincinnati, Cincinnati, USA</addr-line></aff><author-notes><corresp id="cor1">* E-mail:<email>ron.huston@uc.edu(OLH)</email>;</corresp></author-notes><pub-date pub-type="epub"><day>11</day><month>04</month><year>2013</year></pub-date><volume>04</volume><issue>04</issue><fpage>531</fpage><lpage>538</lpage><history><date date-type="received"><day>21</day>	<month>January</month>	<year>2013</year></date><date date-type="rev-recd"><day>3</day>	<month>March</month>	<year>2013</year>	</date><date date-type="accepted"><day>5</day>	<month>April</month>	<year>2013</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
   The title question is investigated by comparing results of a series of bone strength tests of lumbar vertebrae (L1 and L2) and right wrists (distal radii) of nine cadavers. The paper describes the specimen preparation, the testing, and the analysis procedures. The results show that there is a correlation between the strengths of the lumbar and wrist specimens for the individual cadavers, suggesting that bone integrity is indeed systemic. 
 
</p></abstract><kwd-group><kwd>Osteoporosis; Bone Mineral Density; Bone Fracture; Bone Strength</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. INTRODUCTION</title><p>At an NIH conference in 2000, osteoporosis was defined as: “a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture” [<xref ref-type="bibr" rid="scirp.29893-ref1">1</xref>].</p><p>In a relatively recent report (2011) the US Preventive Services Task Force (USPSTF) [<xref ref-type="bibr" rid="scirp.29893-ref2">2</xref>] estimated that 12 million Americans currently have osteoporosis and that “half of all post-menopausal women will have an osteoporosis-related fracture during their lifetime.”</p><p>The excessive cost of this widespread disease includes not only treatment but also the cost of diagnosis. Currently firm diagnosis typically occurs after a bone fracture via X-ray or MRI imaging of the large bones. However, if diagnosis could be made simpler and sooner, the cost of diagnosis could be reduced and preventive measures (e.g. Diet/exercise as discussed by Dimov (2010)) could be taken [<xref ref-type="bibr" rid="scirp.29893-ref3">3</xref>].</p><p>If osteoporosis is systemic, as opposed to being localized in large bones and vertebrae, then using advanced imaging techniques, diagnosis using extremities is feasible. Indeed, Oyen et al. (2010) [<xref ref-type="bibr" rid="scirp.29893-ref4">4</xref>] discovered in a recent study that 1/3 to 1/2 of elderly persons (over age 50) with low-energy distal radius fracture have low bone mineral density (BMD).</p><p>In vivo MRI studies show that micro MRI imaging can detect architectural changes in trabecular bone of the distal radii. These changes are believed to be good biomarkers for osteoporosis. That is, if a systemic nature of osteoporosis can be established, technical advances in imaging can be used for early osteoporosis diagnosis.</p><p>To test the systemic hypothesis, we physically measured and compared the bone strengths of lumbar vertebrae and distal radii of nine cadavers with varying degrees of low bone mineral densities. The results suggest a strong correlation between the strengths of the vertebrae and the radii for individual cadavers.</p><p>The balance of the paper is divided into five parts with the first part describing the physical testing, which is then followed by listings of measurement and testing results. The next two parts provide an analysis of the data and subsequent computed results. The final part is a discussion with concluding remarks.</p></sec><sec id="s2"><title>2. PHYSICAL TESTING</title><sec id="s2_1"><title>2.1. Vertebrae</title><p>Once harvested the lumbar vertebrae (L1 and L2) were cut through the discs so that the specimens then had flat superior and inferior surfaces. Also, the spinous processes were removed resulting in specimens in the form of short cylinders having curved perimeters as depicted in <xref ref-type="fig" rid="fig1"><xref ref-type="fig" rid="fig">Figure </xref>1</xref>, where the principal dimensions are shown.</p><p>We used a dial caliper to measure the five dimensions of <xref ref-type="fig" rid="fig1"><xref ref-type="fig" rid="fig">Figure </xref>1</xref> for the 18 specimens used in the testing (9 L1 and 9 L2).</p><p>After taking these measurements we placed the specimens in shallow plastic flat-dishes containing a liquid cold-curing resin. Upon hardening the specimens were inverted and the other end (superior end) was placed in hardening resin dishes with care taken to keep the superior/inferior dish surfaces parallel. <xref ref-type="fig" rid="fig2"><xref ref-type="fig" rid="fig">Figure </xref>2</xref> shows a sketch of the resulting vertebral specimen constructs.</p><p>Next, we placed each of the 18 constructs in an Instron tester and compressed them to failure (large displacement with minimal load increase). During the compression we recorded the load/displacement values up to failure and then the failure load itself.</p></sec><sec id="s2_2"><title>2.2. Right Distal Radii</title><p>As with the vertebrae, the distal radii (once harvested) were cut perpendicular to their axes with the proximal and distal cutting planes being parallel. The bone tissue in the cross-sections was found to be near annular ellipses as represented in <xref ref-type="fig" rid="fig3"><xref ref-type="fig" rid="fig">Figure </xref>3</xref>, where the pertinent dimensions are also show. The specimens then have the approximate shape of a truncated annular elliptical conical segment.</p><p>Next, we placed the nine radii constructs in the Instron machine and compressed them to failure. As with the vertebrae, we recorded the load/displacement values up to failure and then the failure load itself.</p></sec></sec><sec id="s3"><title>3. MEASUREMENT AND TESTING RESULTS</title><sec id="s3_1"><title>3.1. Vertebrae</title><p><xref ref-type="table" rid="table1">Table 1</xref> lists the measurements of the geometric parameters shown in <xref ref-type="fig" rid="fig1"><xref ref-type="fig" rid="fig">Figure </xref>1</xref> for the L1 and L2 vertebrae.</p><p><xref ref-type="table" rid="table2">Table 2</xref> lists the failure loads and the slopes of the nearly linear load/displacement relations obtained during the compression testings, for all 18 vertebral specimens.</p></sec><sec id="s3_2"><title>3.2. Right Distal Radii</title><p>Tables 3 and 4 list the measurements of the parameters of <xref ref-type="fig" rid="fig3"><xref ref-type="fig" rid="fig">Figure </xref>3</xref> for the distal and proximal ends of the right radii specimens, and also in <xref ref-type="table" rid="table4">Table 4</xref> the specimen lengths.</p><p>Finally, <xref ref-type="table" rid="table5">Table 5</xref> lists the failure loads and the slopes of the nearly linear load/displacement relations obtained during compression testing.</p></sec></sec><sec id="s4"><title>4. ANALYSIS</title><sec id="s4_1"><title>4.1. Vertebrae</title><p>To determine the vertebral strengths we needed to know their cross-section areas. To this end we used the geometry represented in <xref ref-type="fig" rid="fig1"><xref ref-type="fig" rid="fig">Figure </xref>1</xref> together with the measured data listed in <xref ref-type="table" rid="table1">Table 1</xref>. To facilitate this we divided the vertebral cross-section region into three parts as in <xref ref-type="fig" rid="fig4"><xref ref-type="fig" rid="fig">Figure </xref>4</xref> with circle segments representing the ends and the central region being a near rectangle.</p><p>Using standard handbook mensuration formulas [<xref ref-type="bibr" rid="scirp.29893-ref4">4</xref>] for the segment areas we were able to estimate the vertebral cross-section areas in terms of the measured dimensions of <xref ref-type="fig" rid="fig3"><xref ref-type="fig" rid="fig">Figure </xref>3</xref>. From the summary analysis of the Appendix we obtained the following area algorithm:</p><p>Let t be defined as:</p><disp-formula id="scirp.29893-formula98513"><label>(1)</label><graphic position="anchor" xlink:href="4-7300485\8a5edd91-d2b9-4d57-bfab-63524acaec81.jpg"  xlink:type="simple"/></disp-formula><p>Next, let r be defined as:</p><disp-formula id="scirp.29893-formula98514"><label>(2)</label><graphic position="anchor" xlink:href="4-7300485\679c75b5-a966-431e-b5f6-f4c0d60221c6.jpg"  xlink:type="simple"/></disp-formula><p>Then the cross-section area A of a vertebral specimen is approximately:</p><disp-formula id="scirp.29893-formula98515"><label>(3)</label><graphic position="anchor" xlink:href="4-7300485\96bed57e-1f1b-4162-8707-e5479b247661.jpg"  xlink:type="simple"/></disp-formula><p><xref ref-type="table" rid="table1">Table 1</xref>. Vertebral geometric measurements<sup>1</sup> (see <xref ref-type="fig" rid="fig1"><xref ref-type="fig" rid="fig">Figure </xref>1</xref>).</p><p><img src="4-7300485\c99de934-3b30-4a0f-806b-6d7a964d70fa.jpg" /></p><p><sup>1</sup>Measurements are in inches (in) with millimeters (mm) in parentheses.</p><p><xref ref-type="table" rid="table2">Table 2</xref>. Failure loads and stiffnesses of the 18 vertebral constructs.</p><p><img src="4-7300485\1d364b09-bf64-458a-83a7-9e70165e8ed9.jpg" /></p><p><sup>1</sup>Loads are in pounds (lb) with kiloNewtons (kN) in parentheses. <sup>2</sup>Stiffnesses are in pounds per inch (lb/in) with kiloNewton per meter (kN/m) in parentheses.</p><p>where a, b, c, and e are shown in <xref ref-type="fig" rid="fig1"><xref ref-type="fig" rid="fig">Figure </xref>1</xref>. Once we have values for the cross-section areas, we can readily determine the specimen strength using elementary strength of materials formulas: Specifically, for a uniform cross-section member with length ℓ and cross-section area A, and subjected to a compressive load P as in <xref ref-type="fig" rid="fig5"><xref ref-type="fig" rid="fig">Figure </xref>5</xref>, the shortening δ of the member is simply:</p><disp-formula id="scirp.29893-formula98516"><label>(4)</label><graphic position="anchor" xlink:href="4-7300485\a9c49654-7daf-401a-830c-ceb14b7a3ffb.jpg"  xlink:type="simple"/></disp-formula><p>where E is the elastic modulus (see Beer and Johnston [<xref ref-type="bibr" rid="scirp.29893-ref6">6</xref>]).</p><p>The stress and the strain ε are then defined as</p><p><xref ref-type="table" rid="table3">Table 3</xref>. Distal end geometric measurements<sup>*</sup>.</p><p><img src="4-7300485\61fc6f98-1f7c-4343-bfd6-39a92e61430f.jpg" /></p><p><sup>*</sup>Subscripts d for distal Measurements are in inches (in) with millimeters (mm) in parentheses.</p><p><xref ref-type="table" rid="table4">Table 4</xref>. Proximal end geometric measurements<sup>*</sup> (see <xref ref-type="fig" rid="fig3"><xref ref-type="fig" rid="fig">Figure </xref>3</xref>).</p><p><img src="4-7300485\5e509adb-1ffe-444b-85d4-9e385e024057.jpg" /></p><p><sup>*</sup>Subscripts p for proximal. Measurements are in inches (in) with millimeters (mm) in parentheses.</p><p><xref ref-type="table" rid="table5">Table 5</xref>. Failure loads and stiffnesses of the 9 right radii (wrist) constructs.</p><p><img src="4-7300485\cde22bd0-48ba-4b43-bc23-0788d0ac2d1f.jpg" /></p><p><sup>1</sup>Loads are in pounds (lb) with kiloNewtons (kN) in parentheses. <sup>2</sup>Stiffnesses are in pounds per inch (lb/in) with kiloNewtons per meter (kN/m) in parentheses.</p><p><img src="4-7300485\8b9d667b-1865-4da7-af73-003a6a154270.jpg" />and <img src="4-7300485\722cade6-e828-4a84-ab35-02e940d1b7ea.jpg" /> &#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160;(5)</p><p>with the “strength” being the maximum stress value <img src="4-7300485\9ed7ff6e-0ea5-4be4-a7d1-4c43577d818c.jpg" /> occurring at the failure load<img src="4-7300485\e340370f-3ed3-43bb-a8cc-0f01817b423b.jpg" />, or at the collapse of the specimen member.</p><p>The elastic modulus E is a measure of the stiffness of the specimen. It is simply the slope k of the linear portion of a graphical representation between the stress σ and the strain ε, or equivalently, between the load P and the displacement δ. That is, from Eqs.4 and 5 we have</p><p><img src="4-7300485\37d791ff-3155-40ed-9c0a-b5cb28f106dc.jpg" />or <img src="4-7300485\65a14ef1-0092-417f-978e-b203c3ad228a.jpg" /> (6)</p><p>Where Δ is a finite difference.</p><p>The strength <img src="4-7300485\77d79a0f-b364-4257-a76d-20f3ee6474db.jpg" /> and the stiffness E are thus measures of the structural integrity of the vertebral specimens and thus can be used for comparison evaluations.</p></sec><sec id="s4_2"><title>4.2. Distal Radii</title><p>As with the vertebrae, we also needed the cross-section areas of the distal radii, to evaluate their strengths. To this end, consider again the sketch of the distal radii bone specimens shown in <xref ref-type="fig" rid="fig3"><xref ref-type="fig" rid="fig">Figure </xref>3</xref>. Although the specimens have a longitudinal taper, the measurements recorded in Tables 4 and 5 show that the taper is slight, so that for deformation and stress calculations it is reasonable to simply assume a linear cross-section area change.</p><p>The bone content of the radii cross-sections are nearly annular ellipses. Therefore, with an ellipse area being:<img src="4-7300485\f67b4417-4d59-408b-b555-9993f91e8dd7.jpg" />, with a and b being semi-major and semi-minor axes, the distal and proximal cross-section areas are:</p><disp-formula id="scirp.29893-formula98517"><label>(7)</label><graphic position="anchor" xlink:href="4-7300485\b2a09306-4061-4d2e-91b2-a93864b83638.jpg"  xlink:type="simple"/></disp-formula><p>The average bone cross-section is then</p><disp-formula id="scirp.29893-formula98518"><label>(8)</label><graphic position="anchor" xlink:href="4-7300485\9aa54458-4158-4b15-94bc-d2b05441bd01.jpg"  xlink:type="simple"/></disp-formula><p>Consider again the side view of the radius specimen as in <xref ref-type="fig" rid="fig3"><xref ref-type="fig" rid="fig">Figure </xref>3</xref> and as shown again in <xref ref-type="fig" rid="fig6"><xref ref-type="fig" rid="fig">Figure </xref>6</xref> identifying the end areas and with an axial coordinate y. Then we see that the cross-section area A(y) along the axis of the specimen is:</p><disp-formula id="scirp.29893-formula98519"><label>(9)</label><graphic position="anchor" xlink:href="4-7300485\96d7fb0b-ff5e-41b2-b983-f7c5c9945555.jpg"  xlink:type="simple"/></disp-formula><p>Beer and Johnston [<xref ref-type="bibr" rid="scirp.29893-ref6">6</xref>] state that the shortening δ of the tapered specimen is given by the formula:</p><disp-formula id="scirp.29893-formula98520"><label>(10)</label><graphic position="anchor" xlink:href="4-7300485\0d47a17f-0456-440b-8ce7-ccc4c9326699.jpg"  xlink:type="simple"/></disp-formula><p>By substituting for A from Eq.9 we find δ to be:</p><disp-formula id="scirp.29893-formula98521"><label>(11)</label><graphic position="anchor" xlink:href="4-7300485\ce151912-896b-48f3-bc32-6e388482ab12.jpg"  xlink:type="simple"/></disp-formula><p>In the course of the loading of the specimen (before collapse) we found the loading and the deformation to be linearly related. That is,</p><disp-formula id="scirp.29893-formula98522"><label>(12)</label><graphic position="anchor" xlink:href="4-7300485\d95c36ad-5856-4517-889f-fef98ae8febe.jpg"  xlink:type="simple"/></disp-formula><p>where, as with the vertebrae, the stiffness constant k may be identified as the slope of the newly linear load/displacement relation.</p></sec></sec><sec id="s5"><title>5. COMPUTED RESULTS</title><sec id="s5_1"><title>5.1. Vertebrae</title><p><xref ref-type="table" rid="table6">Table 6</xref> lists the cross-section areas of the L1 and L2 specimens, calculated using the formulas of Eqs.1-3, and the resulting strengths and elastic moduli.</p><p>We used the failure load data of <xref ref-type="table" rid="table2">Table 2</xref> and the computed areas to obtain the strengths of the vertebrae. Also, by using the stiffnesses listed in <xref ref-type="table" rid="table2">Table 2</xref> we obtained the elastic moduli using Eq.6.</p></sec><sec id="s5_2"><title>5.2. Distal Radii</title><p>The radii strengths and elastic moduli can be computed using the failure loads and stiffness values listed in <xref ref-type="table" rid="table6">Table 6</xref>, the measured geometric dimensions of Tables 3 and 4, and then Eqs.7, 8 and 13, to determine the numerical results. To this end, it is helpful to initially determine the cross-section area parameters of Eqs.8 and 13.</p><p>In view of Eq.8, it is helpful to compute some area ratios needed for determining the elastic modulus. Also, it is useful to have the product of the construct height h (see <xref ref-type="fig" rid="fig3"><xref ref-type="fig" rid="fig">Figure </xref>3</xref>) and the stiffness k of <xref ref-type="table" rid="table5">Table 5</xref>. To this end <xref ref-type="table" rid="table7">Table 7</xref> lists the distal, proximal and average areas and area ratios and stiffness-height products of the bone content of the various radii.</p><p>Finally, using failure loads listed in <xref ref-type="table" rid="table5">Table 5</xref> and the parameters of <xref ref-type="table" rid="table7">Table 7</xref>, we obtain the radii strengths and elastic moduli as listed in <xref ref-type="table" rid="table8">Table 8</xref>.</p></sec></sec><sec id="s6"><title>6. DISCUSSION AND CONCLUSIONS</title><p><xref ref-type="table" rid="table9">Table 9</xref> summarizes the foregoing results providing a comparison between the strengths of the specimen constructs from the three sites. A glance at the results shows the general trend that there is a correlation between the strengths of the distal radii and the vertebrae for the corresponding cadavers. There is an especially strong correlation between the radii and the L2 vertebrae.</p><p>Observe also in <xref ref-type="table" rid="table9">Table 9</xref> that the strengths of the wrist radii are generally higher than those for the vertebrae.</p><p><xref ref-type="table" rid="table6">Table 6</xref>. Vertebral construct cross-section areas, strengths, and elastic moduli.</p><p><img src="4-7300485\67a3d313-494b-4b83-b80a-1045a810d8cf.jpg" /></p><p>Values are in square inches (in<sup>2</sup>) with square centimeters (cm<sup>2</sup>) in parentheses, and in pounds per square inch (psi) with mega Pascals (mPa) in parentheses.</p><p><xref ref-type="table" rid="table7">Table 7</xref>. Cross-section areas of distal radii bone, area ratios and stiffness-height products.</p><p><img src="4-7300485\66ca19c4-3915-4899-b377-322c210d4c85.jpg" /></p><p><sup>*</sup>Values are in square inches (in<sup>2</sup>) with square centimeters (cm<sup>2</sup>) in parentheses; <sup>**</sup>Units in reciprocal square inches (in<sup>–2</sup>); <sup>***</sup>Units in pounds.</p><p><xref ref-type="table" rid="table8">Table 8</xref>. Strengths and elastic moduli for the distal radii.</p><p><img src="4-7300485\774d20f9-f52c-422b-9322-a1e3df601fc8.jpg" /></p><p>Values are in pounds per square inch (psi) with megaPascals (mPa) in parentheses.</p><p><xref ref-type="table" rid="table9">Table 9</xref>. Strength comparisons for the three construct.</p><p><img src="4-7300485\70515163-6f53-43ff-baff-c28efaf5a322.jpg" /></p><p>Values are in pounds per square inch (psi) with megaPascals (mPa) in parentheses.</p><p>This is to be expected since the radii bone is cortical whereas the vertebrae have load sharing between cortical and trabecular bone. Eswaran, et al. (2006) [<xref ref-type="bibr" rid="scirp.29893-ref7">7</xref>] discuss this effect in detail.</p></sec><sec id="s7"><title>7. ACKNOWLEDGEMENTS</title><p>The authors acknowledge and appreciate the assistance of Richard Banto, Dale Weber, Y. Su, Susan Neuman, and Linda Levin.</p></sec><sec id="s8"><title>REFERENCES</title></sec><sec id="s9"><title>APPENDIX</title><p>To establish a basis for Eqs.1-3, consider the circle segment in <xref ref-type="fig" rid="fig">Figure </xref>A. From Reference [<xref ref-type="bibr" rid="scirp.29893-ref5">5</xref>] and/or other handbooks, the area K of the shaded region is:</p><disp-formula id="scirp.29893-formula98523"><label>(A1)</label><graphic position="anchor" xlink:href="4-7300485\7bd59e02-651a-4a9e-ba9e-46bd58bbc6d1.jpg"  xlink:type="simple"/></disp-formula><p>In view of the dimensions a, &#183;&#183;&#183;, e of <xref ref-type="fig" rid="fig">Figure </xref>A, we immediately see that t and m are</p><disp-formula id="scirp.29893-formula98524"><label>(A2)</label><graphic position="anchor" xlink:href="4-7300485\6b6eeee0-39bc-4266-a0fc-5caa11c56118.jpg"  xlink:type="simple"/></disp-formula><p><img src="4-7300485\63446c49-551b-4771-a8d9-9ae1ce6b8bd4.jpg" /></p><p><xref ref-type="fig" rid="fig">Figure </xref>A. Circle segment.</p><p>Also from [<xref ref-type="bibr" rid="scirp.29893-ref5">5</xref>] m, t, and r are related to each other by the expression:</p><disp-formula id="scirp.29893-formula98525"><label>(A3)</label><graphic position="anchor" xlink:href="4-7300485\67316298-8bf4-421e-a2f6-6b2765ba1ab2.jpg"  xlink:type="simple"/></disp-formula><p>By solving for r we have</p><disp-formula id="scirp.29893-formula98526"><label>(A4)</label><graphic position="anchor" xlink:href="4-7300485\ab65488e-c915-41ae-806b-17f06b407521.jpg"  xlink:type="simple"/></disp-formula><p>Referring again to <xref ref-type="fig" rid="fig1"><xref ref-type="fig" rid="fig">Figure </xref>1</xref> and also to <xref ref-type="fig" rid="fig4"><xref ref-type="fig" rid="fig">Figure </xref>4</xref> we see that the cross section areas A of the vertebral specimens may be represented as:</p><disp-formula id="scirp.29893-formula98527"><label>(A5)</label><graphic position="anchor" xlink:href="4-7300485\25984da5-b405-42ae-94c4-2e80d624246a.jpg"  xlink:type="simple"/></disp-formula><p>or</p><disp-formula id="scirp.29893-formula98528"><label>(A6)</label><graphic position="anchor" xlink:href="4-7300485\067bf19e-3ad2-4ab0-aacb-0b3c0df1ee0b.jpg"  xlink:type="simple"/></disp-formula><p>Eqs.A2, A4, and A6 form the basis for the algorithm of Equations.</p></sec></body><back><ref-list><title>References</title><ref id="scirp.29893-ref1"><label>1</label><mixed-citation publication-type="other" xlink:type="simple">National Institutes of Health (2000) NIH consensus development conference on osteoporosis.</mixed-citation></ref><ref id="scirp.29893-ref2"><label>2</label><mixed-citation publication-type="journal" xlink:type="simple"><name name-style="western"><surname>US Preventive Services Task Force </surname><given-names>  </given-names></name>,<etal>et al</etal>. (<year>2011</year>)<article-title>Screening for osteoporosis: Recommendation statement</article-title><source> American Family Phyisican</source><volume> 83</volume>,<fpage> 1197</fpage>-<lpage>1200</lpage>.<pub-id pub-id-type="doi"></pub-id></mixed-citation></ref><ref id="scirp.29893-ref3"><label>3</label><mixed-citation publication-type="other" xlink:type="simple">Dimov, M., Khoury, J.D. and Tsang, R.C. (2010) Bone mineral loss during pregnancy: Is tennis protective? Journal of Physical Activity &amp; Health, 7, 239-245.</mixed-citation></ref><ref id="scirp.29893-ref4"><label>4</label><mixed-citation publication-type="journal" xlink:type="simple"><name name-style="western"><surname>Oyen</surname><given-names> J.</given-names></name>,<name name-style="western"><surname> Gjesdal</surname><given-names> C.G.</given-names></name>,<name name-style="western"><surname> Brudvik</surname><given-names> C.</given-names></name>,<name name-style="western"><surname> Hove</surname><given-names> L.M.</given-names></name>,<name name-style="western"><surname> Apalset</surname><given-names> E.M.</given-names></name>,<name name-style="western"><surname> Sulseth</surname><given-names> H.C. and Hangeberg</given-names></name>,<name name-style="western"><surname> G. </surname><given-names>  </given-names></name>,<etal>et al</etal>. (<year>2010</year>)<article-title>Low-energy distal radius fractures in middle-aged and elderly men and women—The burden of osteoporosis and fracture risk—A study of 1794 consecutive patients</article-title><source> Osteoporosis International</source><volume> 21</volume>,<fpage> 1257</fpage>-<lpage>1267</lpage>.<pub-id pub-id-type="doi"></pub-id></mixed-citation></ref><ref id="scirp.29893-ref5"><label>5</label><mixed-citation publication-type="other" xlink:type="simple">Selby, S.M. (1972) CRC standard mathematical tables. 20th Edition, The Chemical Rubber Col, Cleveland.  
doi:10.1007/s00198-009-1068-x</mixed-citation></ref><ref id="scirp.29893-ref6"><label>6</label><mixed-citation publication-type="other" xlink:type="simple">Beer, F.P. and Johnston Jr., E.R. (1992) Mechanics of materials. 2nd Edition, McGraw-Hill, New York.</mixed-citation></ref><ref id="scirp.29893-ref7"><label>7</label><mixed-citation publication-type="other" xlink:type="simple">Eswaran, S.K., Gupta, A., Adams, M.F. and Keaveny, T.M. (2006) Cortical and trabecular load sharing in the human vertebral body. Journal of Bone and Mineral Research, 21, 307-313. doi:10.1359/jbmr.2006.21.2.307</mixed-citation></ref></ref-list></back></article>