Value of impact microindentation in the evaluation of bone fragility in clinical practice

Schoeb, M. (2026)

Doctoral Thesis

Osteoporosis and other metabolic bone disorders increase fracture risk, but bone mineral density (BMD) alone does not fully capture bone strength. Bone material properties also contribute to bone fragility but are difficult to assess in clinical practice. Impact Microindentation (IMI) is a minimally invasive technique that measures bone material properties in vivo and provides the Bone Material Strength index (BMSi). This thesis evaluates the clinical value of IMI in the assessment of bone fragility. It examines BMSi in individuals with low- and high-energy trauma fractures, changes in BMSi during osteoporosis treatment, and BMSi in patients with primary hyperparathyroidism and Cushing’s syndrome. In addition, the safety and acceptability of the procedure are evaluated. The findings provide further insight into the potential of IMI as a complementary tool for assessing bone fragility beyond conventional BMD measurements and identify areas requiring further investigation before its implementation in routine clinical practice.

• Impact Microindentation
• Bone Material Strength index
• Bone fragility
• Bone quality
• Bone material properties
• Osteoporosis
• Fragility fractures
• Primary hyperparathyroidism
• Cushing’s syndrome

• All authors: Schoeb, M.
• Supervisor: Appelman-Dijkstra, N.M.
• Co-supervisor: Hamdy, N.A.T.
• Committee: Pereira Arias, A.M.; Busse, B.; Biermasz, N.R.; Schipper, I.B.; Bergh, J.P.W. van den
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2026-09-23
• ISBN (print): 9789465346458