Development and Validation of a Predictive Bone Fracture Risk Model for Astronauts
Abstract
There are still many unknowns in the physiological response of human beings to space, but compelling evidence indicates that accelerated bone loss will be a consequence of long-duration spaceflight. Lacking phenomenological data on fracture risk in space, we have developed a predictive tool based on biomechanical and bone loading models at any gravitational level of interest. The tool is a statistical model that forecasts fracture risk, bounds the associated uncertainties, and performs sensitivity analysis. In this paper, we focused on events that represent severe consequences for an exploration mission, specifically that of spinal fracture resulting from a routine task (lifting a heavy object up to 60 kg), or a spinal, femoral or wrist fracture due to an accidental fall or an intentional jump from 1 to 2 m. We validated the biomechanical and bone fracture models against terrestrial studies of ground reaction forces, skeletal loading, fracture risk, and fracture incidence. Finally, we predicted fracture risk associated with reference missions to the moon and Mars that represented crew activities on the surface. Fracture was much more likely on Mars due to compromised bone integrity. No statistically significant gender-dependent differences emerged. Wrist fracture was the most likely type of fracture, followed by spinal and hip fracture.
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Terrestrial evidence shows that loss of bone matrix and bone mineral due to prolonged bed rest (e.g., disuse medical conditions and/or spinal cord injury) eventually plateaus at 69.0% initial BMD after a period of significant and progressive decline.
“Furthermore, there is terrestrial evidence that the loss of bone matrix and bone mineral due to conditions that result prolonged bed rest (e.g. disuse medical conditions and/or spinal cord injury) eventually plateaus at 69.0% initial BMD, after a period of significant and progressive decline [18,20,21].”
From A human mission to Mars: Predicting the bone mineral density loss of astronauts (2020) · cites this paper as [18]
BMD loss in the femoral neck has been modeled as a linear decrease of (1.06 ± 0.63)% per month.
“Specifically, BMD loss in the femoral neck has been modeled as a linear decrease: (1.06 ± 0.63)% BMD loss per month [17,18].”
From A human mission to Mars: Predicting the bone mineral density loss of astronauts (2020) · cites this paper as [18]
The maximum total BMD loss has been previously estimated to be 69.0% relative to astronauts' pre-flight BMD, obtained by combining data from different large studies in humans.
“The maximum total BMD loss has been previously estimated to be 69.0% relative to the astronauts’ pre-flight BMD [18], and obtained by combining data from different large studies in humans [23,24].”
From A human mission to Mars: Predicting the bone mineral density loss of astronauts (2020) · cites this paper as [18]
Femoral neck is recommended by the World Health Organization (WHO) to determine the fragility fracture risk associated T-score and to diagnose osteoporosis in clinical practice.
“Femoral neck was chosen between other weight-bearing bones because it is the recommended by the World Health Organization (WHO) [25] to determine the fragility fracture risk associated T-score, as well as to diagnose osteoporosis in clinical practice [18].”
From A human mission to Mars: Predicting the bone mineral density loss of astronauts (2020) · cites this paper as [18]
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References 133 · Cited by 50
- Authors
- Nelson, E. S., Lewandowski, B., Licata, A., & Myers, J. G.
- Affiliations
- Glenn Research Center (US)
- Cleveland Clinic (US)
- Corresponding author
- Nelson, Emily S.
- Venue
- Annals of Biomedical Engineering
- Published
- 2009-08-26
- Volume
- 37
- Issue
- 11
- Pages
- 2337-2359
- ISSN
- 0090-6964 (ISSN-L)
- 1573-9686
- OpenAlex
- W1974390461
- Cited by
- 50
- References
- 133
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 2 · 2021: 6 · 2020: 2 · 2019: 4 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 3 · 2013: 5 · 2012: 3
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Annals of Biomedical Engineering (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Spaceflight effects on biology
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Physical Sciences › Engineering › Aerospace Engineering › Space Exploration and Technology
- Keywords
- bone fracture risk, astronauts, spaceflight, bone loss, spinal fractures, femoral fracture, wrist fractures, bone loading, biomechanical modeling, ground reaction force, fracture risk prediction, lunar and Mars missions, gender differences, microgravity
- MeSH terms
- Computer Simulation, Fractures, Spontaneous, Humans, Models, Biological, Risk Factors, Space Flight, Weightlessness, Bone Density, Astronauts, Risk Assessment, Fractures, Bone, Elastic Modulus
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