 The variation in the components of the stiffness tensor shows anisotropic damage which depends on the considered load case (Figure [0](#F0){ref-type="fig"}). Shi et al. ([@B00]) suggested that there is a larger proportion of damaged tissue in the longitudinal trabeculae (direction of loading) for uniaxial load cases, which is in agreement with the results presented here, as the most damaged components of the macroscopic stiffness tensor are always the on-axis components. An issue which may make validation of these results very challenging is the use of kinematic uniform boundary conditions; these boundary conditions are extremely difficult, not to say impossible, to reproduce experimentally, especially for the more complex load cases. Most previous studies involving damage in trabecular bone have used isotropic models (Garcia et al., [@B00]; Schwiedrzik and Zysset, [@B00]), which may be acceptable for proportional loading scenarios, but not for changing loads or cyclic loading scenarios, such as those arising during physiological activities.  