Hierarchical perspective of bone toughness - From molecules to fracture

Osteoporotic and age-related fractures are a significant public health problem. The current standard of osteoporosis assessment via bone mineral density has been shown to be inadequate for fracture risk predictions highlighting the importance of material composition and structural design of bone in determining skeletal fragility. Bone is a hierarchical material that derives its fracture resistance from various mechanisms that act at length scales ranging from nano-to macroscale. Recent research efforts have focussed on the understanding of bone fracture based on this hierarchical structure to provide a more reliable assessment of fracture risk. Understanding the function, contribution and interaction of each length scale to bone toughness is a crucial step to develop new strategies for fracture risk assessment, fracture prevention, and development of therapeutic interventions for disease and age-related changes in bone. This review presents a hierarchical perspective of bone toughness ranging from nano-to macroscale and reports on the current state of knowledge in the areas of experimental and computational approaches to bone fracture.