Reference Intervals for Bone Impact Microindentation in Healthy Adults: A Multi-Centre International Study

Pamela Rufus-Membere, Kara L. Holloway-Kew, Adolfo Diez-Perez, Natasha M. Appelman-Dijkstra, Mary L. Bouxsein, Erik F. Eriksen, Joshua N. Farr, Sundeep Khosla, Mark A. Kotowicz, Xavier Nogues, Mishaela Rubin, Julie A. Pasco

Research output: Contribution to journalArticlepeer-review


Impact microindentation (IMI) is a novel technique for assessing bone material strength index (BMSi) in vivo, by measuring the depth of a micron-sized, spherical tip into cortical bone that is then indexed to the depth of the tip into a reference material. The aim of this study was to define the reference intervals for men and women by evaluating healthy adults from the United States of America, Europe and Australia. Participants included community-based volunteers and participants drawn from clinical and population-based studies. BMSi was measured on the tibial diaphysis using an OsteoProbe in 479 healthy adults (197 male and 282 female, ages 25 to 98 years) across seven research centres, between 2011 and 2018. Associations between BMSi, age, sex and areal bone mineral density (BMD) were examined following an a posteriori method. Unitless BMSi values ranged from 48 to 101. The mean (± standard deviation) BMSi for men was 84.4 ± 6.9 and for women, 79.0 ± 9.1. Healthy reference intervals for BMSi were identified as 71.0 to 97.9 for men and 59.8 to 95.2 for women. This study provides healthy reference data that can be used to calculate T- and Z-scores for BMSi and assist in determining the utility of BMSi in fracture prediction. These data will be useful for positioning individuals within the population and for identifying those with BMSi at the extremes of the population.

Original languageEnglish (US)
Pages (from-to)338-349
Number of pages12
JournalCalcified Tissue International
Issue number3
StatePublished - Mar 2023


  • Bone material strength index
  • Impact microindentation
  • Normative data
  • Osteoporosis
  • Reference interval

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine
  • Endocrinology


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