Scientists Discover What Makes Bones Fracture-Resistant (It's Not What They Thought!) - Save Our Bones

A team of researchers at Cornell University has unlocked a long-standing mystery of bone mechanics. Aside from elucidating valuable information for supporting bone health, their discovery has far-reaching implications for a variety of fields interested in building durable materials that resist fracture.

They found that measurements of bone density, and even the way that bone strength is typically defined, fail to consider a critical component of a bone's fracture resistance.

Today we'll dive into their research to learn how a misunderstood part of bone microarchitecture plays an important role in fracture prevention.

The Incredible Structure Of Cancellous Bone

A study published in the journal PNAS has uncovered a previously unknown trait of cancellous bone. Cancellous bone is one of the primary types of bone tissue. It is composed of a lattice-like matrix of minerals and has an almost spongy appearance.

Anyone who has learned about osteoporosis has seen side-by-side images of cancellous bone. They usually depict healthy bone alongside bone in which the struts of the mineral lattice called trabeculae have thinned, resulting in bone tissue that has more holes than it does bone.

This lattice-like structure might seem unstable because it isn't filled in with minerals, but this shape is incredibly strong. In fact, engineers have modeled highly durable materials by copying the architecture of cancellous bone.

However, this study has provided a deeper understanding of the physics behind the structure's strength.


Cancellous bone is a type of bone tissue composed of a lattice-like matrix of minerals. The struts of the lattice are called trabeculae. During bone loss, these trabeculae become thin, weakening bone. This study has generated a new understanding of what makes this lattice strong.

The Importance Of Trabeculae

Trabeculae, the struts of the lattice in cancellous bone, generally run in two directions:
longitudinally, in parallel with the force typically applied to the bone; and transversely, perpendicular to that typical force.

Since humans walk upright on two legs, most of the force applied to our bones is vertical. Longitudinal trabeculae tend to be thought of as the most important trabeculae since they bear the brunt of the load placed on human bones. And indeed, in trauma fractures (during a fall or an accident) the amount of force required to break a bone bears a direct relationship to the size and density of those longitudinal trabeculae.

However, that's not the only type of fracture. Fatigue fractures occur not because of a single trauma, but due to the effect over time of cyclical loading. Cyclical loading describes any repeated force applied to a material.

Up until now, it has been assumed that longitudinal trabeculae are also the most important factor for resisting fatigue fracture. But researchers at Cornell University have proven that assumption wrong.

They found that the thickness of the transverse trabeculae dictated the cancellous bone's ability to withstand cyclic loading and prevent fracture.1


Longitudinal trabeculae, which align with the force typically applied to a bone, have long been thought the most important part of bone strength. This study found that in the case of fatigue fracture caused by cyclical loading, the transverse trabeculate dictated the cancellous bone's ability to resist fracture.

About The Study

To come to this conclusion, researchers first used a machine to test the durability of different donated bone samples under cyclical loading. This experiment showed that transverse trabeculae were associated with increased resistance to cyclical loading– they lasted longer without fracture.1

Then, the researchers double-checked this result. They used a 3-D printer to replicate samples of cancellous bone that were each identical save one variable: the thickness of their transverse trabeculae.

They tested those 3-D printed samples using the cyclical loading machine and found the same result. As the thickness of the transverse trabecula increased, the ability of the sample to withstand fatigue fracture from cyclical loading increased.

This discovery has enormous implications for fields like aerospace engineering, where super lightweight and strong materials are required, and engineers need to predict how long the components will be safe to use.

It also has a significant bearing on our understanding of bone health and what makes bones strong and durable.


The scientists put bone samples into a cyclical loading machine to see how many cycles of loading it would take before the bone fractured. They found an association between the thickness of transverse trabeculae and the durability of the bone. Then they 3D-printed samples of bone, identical save the thickness of transverse trabeculae. They ran the same durability test and found the same result.

Density Isn't The Best Predictor Of Bone Health

This groundbreaking study reaffirms the fact that bone mineral density is not useful as a sole predictor of fracture risk. The Osteoporosis Reversal Program was founded on clear scientific evidence of this fact. This new research proves the position correct yet again– and offers a new mechanical explanation for why.

Density measurements can help to predict a bone's resistance to fracture from a single overload of force, say from a fall or a car accident. However, the most common type of osteoporosis-related fracture is vertebral fracture caused not by a single incident but by fatigue from cyclical loading.

Here's what the study's authors had to say:

“Preferential loss of transversely oriented trabeculae during aging, therefore, causes reductions in the fatigue life of cancellous bone that are disproportionately larger than the reductions in stiffness and strength, potentially explaining the long-held but poorly described relationship between cancellous bone microstructure and clinical fractures.”1

DXA scans that offer readings of bone mineral density (BMD) provide information about bone stiffness and strength. But as this study shows, that's not the whole picture.

Osteoporosis drugs that aim to increase BMD are not improving– or even considering– all of what makes bones resistant to fracture. This incomplete approach has incomplete results. Bisphosphonates (the leading class of osteoporosis drugs) create stiff bones that are not durable, which results in one of their most dangerous and counter-intuitive side effects: atypical femoral fractures.

This new study helps us to understand exactly why the osteoporosis drugs that Big Pharma markets are not up to the task of safely improving bone health and preventing fractures.


This study shows how bone mineral density (BMD) is insufficient for measuring the strength, health, and durability of bone. Osteoporosis drugs that aim to increase BMD are not considering the full picture of what makes bones susceptible to fracture.

What This Means To You

Our bones are marvels of engineering, so complex that we're still unlocking the secrets of how they work. That's why it's important to keep learning and adjusting our approach to preserving the health and durability of our bones.

The Save Institute is committed to keeping you up to date. We're continually crafting the best possible approach to preventing and reversing osteoporosis– an approach you'll find in the Osteoporosis Reversal Program.

The ORP is an evidence-based, all-natural way to build stronger, healthier, more durable bones that will last a lifetime. Start with learning, then use that knowledge to choose a safer path to stronger bones.



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Comments on this article are closed.

  1. Dora

    The best is to try different brands till you find one you like. I use Blue Diamond unsweetened, with vanilla. That is the one I prefer. It has only 30 calories. You can add a sweetener, if needed. I do not buy the long-lasting versions that you may find along an aisle at a store, so I only buy a carton from the fridge section. Oat milk is also a good choice.

  2. Sharon Dezelske

    My daughter has lobular stage 4 breast cancer. Her dr has set her up with Ibrance for the cancer and since it’s estrogen driven, she takes a shot that put her in menopause immediately for that once a month. She’s also taking a biophosphate med for bone deterioration that worries me. I would like her to get off that and try an 80/20 diet. Right now the cancer is in remission. Any suggestions?
    Thank you. I realize you are not allowed to give any medical advice but how about nutrition advice?

    • Vivian Goldschmidt, MA

      I’m sorry about your daughter’s condition! It turns out that a pH-balanced diet is helpful for other health issues besides osteoporosis and osteopenia. Studies done in a laboratory setting have shown that cancer cells reproduce more effectively in an acidic environment. This study on breast cancer cells and pH explains more:

      The researchers conclude that “Based on these results, we suggest that controlling or maintaining an unfavorable pH (such as a slightly alkaline pH) for cancer cells in vivo could retard the growth of cancer cells or potentially treat the cancer.”

      I hope she’ll stay in remission and she’ll live a long and healthy life!

  3. Pam

    I recently had a bone density scan which shows osteoporosis, but they also ran a trabecula bone score which showed that fracture risk is severe.
    Can you help me understand this and if osteoporosis drugs would be the only way to correct this?

    • Save Institute Customer Support

      Dear Pam,

      At the Save Insitute, we never recommend taking osteoporosis drugs. And we’re happy to help you out, so please check your email inbox within the next 24-48 hours.

      In excellent health,
      Customer Support

      • Jenny Molina

        Dear, Vivian! I would love to consult with you in person. Do you have a practice??
        Thank you in advance,


  4. Donna wert

    Thank you for keeping us abreast of current osteoporosis research.

    • Vivian Goldschmidt, MA

      My pleasure, Donna!

  5. Betty Jo Russ

    Already typed email etc

  6. Melinda

    Thank you for all of the helpful information. I have gone from being told I was osteoporosis to now normal bone densitity. I am 70yrs old. Please keep the information coming. Doctors don’t seem to know anything except to prescribe medicine that destroys bones.

    • Nini

      What did you do to turn osteoporosis to normal bone ???

    • Vivian Goldschmidt, MA

      You’re very welcome, Melinda! And I congratulate you on your results. Thanks for sharing this with our community. Stay healthy and enjoy every day of your healthy life!

  7. Deborah P

    That research about bone mechanics was very valuable to me. It clearly explains what determines bone strength and why bisphosphonates only serve to complicate matters. Now I feel better informed to counter the lies of the bone druggers. Thank you!

    • Vivian Goldschmidt, MA

      I’m so glad you find this article useful, Deborah! And you’re very welcome 🙂

  8. Pat

    This message is for Jane who has taken 2 years of Forteo & now on Prolia injections. I too started Forteo last year but could only tolerate the side effects for 3 months & stopped with my doctors’ understanding.
    She indicated I had not been on it long enough to have any pro or con results. The question you could ask is how much did the Forteo increase the DEXA bone density results.
    And what happens if you stop the Prolia at this point.
    Unfortunately there are problems when stopping these drugs. I am still trying to decide how to move forward with my osteoporosis since I’ve already had a hip fix.
    Best to you with these difficult choices.

    • Betty Jo Russ

      I am suffering from osteoporosis. And I don’t know which treatment to access. My doctors give me many choices but All are related to Big Pharma and very expensive. I am 79 years old and had back surgery so I have 4 screws and 2 rods and I also have scoliosis. Which the doctor said he didn’t know about after many Xrays Mris and and other scans

  9. Terri Bartlett

    So how do we create transverse trabeculae that are thick enough to provide protection against the fractures you describe? Are there dietary and exercise recommendations to improve this aspect of bone structure?

    • Vivian Goldschmidt, MA

      When you follow a bone-healthy diet, exercise on a regular basis, and avoid toxins, you’ll build healthy bones, including all matrix components.

  10. Pepper Prigal

    I have been following your advice for years. My bones are aging as I am. My sister has been on a new course of treatment, Evenity. What is your opinion?

  11. Julie Kim

    I like to know MBP (milk basic protein) supplement is going to increase bone density.

    • Vivian Goldschmidt, MA

      Julie, milk basic protein contains casein and whey protein. Casein is a slow digesting protein. It can also have undesirable side effects, especially in gluten-intolerant people. Additionally, casein is used to make a strong type of glue for wood bonding and can form mucus in our respiratory system, causing wheezing, coughing, congestion, a runny nose, or itchy eyes.

      So you’re better off taking whey protein, as explained in this article:

      Feel free to reach out should you have more questions 🙂

      • Julie Kim

        Thank you very much for clarifying MBP. I take whey isolate as you have recommended.

  12. Wayfarer

    This article substantiates everything you’ve driven home in my last 8 years as a Save My Bones Member. I’ve had a retried doctor as my training. I experienced a debilitating accident of a slip & fall on both knees coming up a flight of steps. The exercise program He developed for Me encompass the necessary steps of your impacting of bone strength. The Clam exercise was my main course of action that I felt showed predictors of more knee & hip strength.
    Once in awhile I hear a clicking noise in my left hip, should this be of concern to Me’?
    If, so would you be so kind as to address a course of action?
    Thank goodness for you!

    • Vivian Goldschmidt, MA

      Thanks for being a part of the Saver community for all those years! I’m glad you’ve recovered from the fall. Your question would be best answered by an orthopedist who could look at X-rays or other imaging tests to determine what’s going on with your left hip.

    • Jane

      I have been avoiding bisphosphonates but, at the urging of my doctors, have taken two years of forteo and have had my second injection of prolia. I remain terrified of falling as if it were a death sentence and wonder with this new information if I should stop the prolia and just stick with the diet. Thank you for your efforts to educate.

      • Suz

        Jane, be very careful about stopping Prolia if you need to stop that particular drug you increase your risk of spinal fractures. Talk it through with endocrinologist prescribing it. They should have explained that following denosumab (Prolia) you need a strategy due to the sudden proliferation of osteoclasts when that drug is stopped.
        Good luck

      • Vivian Goldschmidt, MA

        Jane, at the Save Institute we don’t recommend taking osteoporosis drugs, but only you can make your own health decisions. Take a look at this article to help you decide:

        Keep us posted!

        • Dolores M Sheehan

          Please I am so co fused about which milk to drink for calcium intake on a daily basis.

          I drink silk almond unsweetened and barely enjoy the taste. I’d like to try the chocolate but I do not want the added sugar.
          I have also tried Califia (unsweetened) as it does not have contain casin.
          Please help. Love my
          Milk !!

          • Dora

            The best is to try different brands till you find one you like. I use Blue Diamond unsweetened, with vanilla. That is the one I prefer. It has only 30 calories. You can add a sweetener, if needed. I do not buy the long-lasting versions that you may find along an aisle at a store (bad taste), so I only buy a carton from the fridge section. Oat milk is also a good choice.

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