Osteoporosis International

, Volume 23, Issue 4, pp 1297–1309 | Cite as

Human bone material characterization: integrated imaging surface investigation of male fragility fractures

  • R. Zoehrer
  • E. Perilli
  • J. S. Kuliwaba
  • J. G. Shapter
  • N. L. Fazzalari
  • N. H. Voelcker
Original Article



The interrelation of calcium and phosphorus was evaluated as a function of bone material quality in femoral heads from male fragility fracture patients via surface analytical imaging as well as scanning microscopy techniques. A link between fragility fractures and increased calcium to phosphorus ratio was observed despite normal mineralization density distribution.


Bone fragility in men has been recently recognized as a public health issue, but little attention has been devoted to bone material quality and the possible efficacy in fracture risk prevention. Clinical routine fracture risk estimations do not consider the quality of the mineralized matrix and the critical role played by the different chemical components that are present. This study uses a combination of different imaging and analytical techniques to gain insights into both the spatial distribution and the relationship of phosphorus and calcium in bone.


X-ray photoelectron spectroscopy and time-of-flight secondary ion mass spectrometry imaging techniques were used to investigate the relationship between calcium and phosphorus in un-embedded human femoral head specimens from fragility fracture patients and non-fracture age-matched controls. The inclusion of the bone mineral density distribution via backscattered scanning electron microscopy provides information about the mineralization status between the groups.


A link between fragility fracture and increased calcium and decreased phosphorus in the femoral head was observed despite normal mineralization density distribution. Results exhibited significantly increased calcium to phosphorus ratio in the fragility fracture group, whereas the non-fracture control group ratio was in agreement with the literature value of 1.66 M ratio in mature bone.


Our results highlight the potential importance of the relationship between calcium and phosphorus, especially in areas of new bone formation, when estimating fracture risk of the femoral head. The determination of calcium and phosphorus fractions in bone mineral density measurements may hold the key to better fracture risk assessment as well as more targeted therapies.


Backscattered scanning electron microscopy Bone mineral density distribution Calcium/phosphorus ratio Male fragility fractures Time-of-flight secondary ion mass spectrometry X-ray photoelectron spectroscopy 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • R. Zoehrer
    • 1
  • E. Perilli
    • 2
    • 3
  • J. S. Kuliwaba
    • 2
    • 3
  • J. G. Shapter
    • 1
  • N. L. Fazzalari
    • 2
    • 3
  • N. H. Voelcker
    • 1
  1. 1.School of Chemical and Physical SciencesFlinders UniversityAdelaideAustralia
  2. 2.Bone and Joint Research Laboratory, Surgical Pathology, SA Pathology and Hanson InstituteAdelaideAustralia
  3. 3.Discipline of Anatomy and PathologyThe University of AdelaideAdelaideAustralia

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