Use of finite element analysis to assess bone strength

Assessment of areal bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) is widely used to diagnose osteoporosis and assess fracture risk. However, clinical observations have highlighted the limitations of DXA with respect to both sensitivity and specificity in fracture risk predictions. From a biomechanics viewpoint, an approach that accurately represents the three-dimensional geometry and heterogeneous distribution of material properties of bone may provide improved estimates of bone strength. In this regard, there is increasing interest in the use of finite element analysis (FEA) to assess bone biomechanical behavior. In this Perspective, we describe the finite element method and review its application in bone research. We discuss the strengths and limitations of the approach, evaluate its potential for clinical assessment of fracture risk, and suggest areas of future research. Rather than provide a comprehensive review on this topic, we highlight current trends in the field and important areas of future inquiry.