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Automated DXA-based finite element analysis for hip fracture risk stratification: a cross-sectional study

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Abstract

Summary

Fracture risk indices (FRIs) generated from DXA-based finite element analysis were associated with hip fracture independent of FRAX score computed with femoral neck bone mineral density (BMD). Prospective studies are warranted to determine whether FRIs represent an improvement over BMD for predicting incident hip fractures.

Introduction

The study aims to examine the association between prior hip fracture and FRIs derived from automated finite element analysis (FEA) of DXA hip scans. Femoral neck, intertrochanteric, and subtrochanteric FRIs were calculated as the von Mises stress induced by a sideways fall divided by the bone yield stress over the specified region of interest (ROI).

Methods

Using the Manitoba Bone Mineral Density Database, we selected women age ≥ 65 years with femoral neck T-scores below − 1 and no osteoporosis treatment. From this population, we identified 324 older women with hip fracture before DXA testing and a random sample of 658 non-fracture controls. FRIs were derived from the anonymized DXA scans. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the associations between FRIs (per SD increase) and hip fracture.

Results

After adjusting for FRAX score (hip fracture with BMD), femoral neck FRI (OR 1.36, 95% CI 1.13, 1.64), intertrochanteric FRI (OR 1.81, 95% CI 1.44, 2.27), and subtrochanteric FRI (OR 2.09, 95% CI 1.68, 2.60) were associated with hip fracture. Intertrochanteric and subtrochanteric FRIs gave significantly higher c-statistics (all P ≤ 0.05) than femoral neck BMD. Subgroup analyses showed that all FRIs were more strongly associated with hip fracture in women who were younger and had higher body mass index (BMI) or non-osteoporotic BMD (all P interaction < 0.1).

Conclusions

FRIs derived from DXA-based FEA were independently associated with prior hip fracture, suggesting that they could potentially improve hip fracture risk assessment.

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Acknowledgements

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC# 2008/2009-33). The results and conclusions are those of the authors, and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Healthy Living and Seniors, or other data providers is intended or should be inferred.

Funding

This study was funded through a Manitoba Partnership Program Grant from Research Manitoba and the Canadian Institutes of Health Research (CIHR# 326175).

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China

    S. Yang

  2. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    S. Yang & L. M. Lix

  3. Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada

    S. Yang & W. D. Leslie

  4. Department of Nuclear Medicine, St. Boniface Hospital, Winnipeg, MB, R2H 2A6, Canada

    W. D. Leslie & L. M. Ward

  5. Department of Radiology, University of Manitoba, Winnipeg, MB, Canada

    W. D. Leslie, A. L. Goertzen & I. Delubac

  6. Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB, Canada

    Y. Luo & S. Ahmed

  7. Department of Biomedical Engineering, Polytech Marseille, Marseille, France

    I. Delubac

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  1. S. Yang
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  2. W. D. Leslie
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  8. L. M. Lix
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Corresponding author

Correspondence to W. D. Leslie.

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Electronic supplementary material

ESM 1

Bone mineral density (BMD) bone map extraction procedure (a) BMD image with proximal femur outline (green), (b) BMD image with femoral head outline (green), (c) BMD image with total femur outline after merging outlines shown in A and B, and (d) final BMD bone map (PPTX 136 kb)

ESM 2

A convergence curve showing the variation of intertrochanteric fracture risk index (FRI) with the number of nodes and a finite element mesh generated from the femoral bone outline (PPTX 179 kb)

ESM 3

(DOCX 18 kb)

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Yang, S., Leslie, W.D., Luo, Y. et al. Automated DXA-based finite element analysis for hip fracture risk stratification: a cross-sectional study. Osteoporos Int 29, 191–200 (2018). https://doi.org/10.1007/s00198-017-4232-8

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  • DOI: https://doi.org/10.1007/s00198-017-4232-8

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