Automation of a DXA-based finite element tool for clinical assessment of hip fracture risk

Accurate assessment of hip fracture risk is very important to prevent hip fracture and to monitor the effect of a treatment. A subject-specific QCT-based finite element model was constructed to assess hip fracture risk at the critical locations of femur during the single-leg stance and the sideways fall. The aim of this study was to improve the prediction of hip fracture risk by introducing a novel failure criterion to more accurately describe bone failure mechanism. Hip fracture risk index was defined using cross-section strain energy, which is able to integrate information of stresses, strains, and material properties affecting bone failure. It was found that the femoral neck and the intertrochanteric region have higher fracture risk than other parts of the femur, probably owing to the larger content of cancellous bone in these regions. The study results also suggested that women are more prone to hip fracture than men. The findings in this study have a good agreement with those clinical observations reported in the literature. The proposed hip fracture risk index based on strain energy has the potential of more accurate assessment of hip fracture risk. However, experimental validation should be conducted before its clinical applications.

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Finite element derived femoral strength is a better predictor of hip fracture risk than aBMD in the AGES Reykjavik study cohort

Bone ◽

10.1016/j.bone.2021.116219 ◽

2022 ◽

Vol 154 ◽

pp. 116219

Author(s):

Ingmar Fleps ◽

Halldór Pálsson ◽

Alexander Baker ◽

William Enns-Bray ◽

Hassan Bahaloo ◽

...

Keyword(s):

Finite Element ◽

Hip Fracture ◽

Fracture Risk ◽

Study Cohort ◽

Hip Fracture Risk ◽

Femoral Strength

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Assessing hip fracture risk in type-2 diabetic patients using CT-based autonomous finite element methods

The Bone & Joint Journal ◽

10.1302/0301-620x.103b9.bjj-2020-2147.r1 ◽

2021 ◽

Vol 103-B (9) ◽

pp. 1497-1504

Author(s):

Dani Rotman ◽

Gal Ariel ◽

Jorge Rojas Lievano ◽

Haggai Schermann ◽

Nir Trabelsi ◽

...

Keyword(s):

Finite Element ◽

Hip Fracture ◽

Fracture Risk ◽

Bone Strength ◽

Strength Parameter ◽

Control Group ◽

Diabetic Patients ◽

Study Group ◽

Hip Fracture Risk

Aims Type 2 diabetes mellitus (T2DM) impairs bone strength and is a significant risk factor for hip fracture, yet currently there is no reliable tool to assess this risk. Most risk stratification methods rely on bone mineral density, which is not impaired by diabetes, rendering current tests ineffective. CT-based finite element analysis (CTFEA) calculates the mechanical response of bone to load and uses the yield strain, which is reduced in T2DM patients, to measure bone strength. The purpose of this feasibility study was to examine whether CTFEA could be used to assess the hip fracture risk for T2DM patients. Methods A retrospective cohort study was undertaken using autonomous CTFEA performed on existing abdominal or pelvic CT data comparing two groups of T2DM patients: a study group of 27 patients who had sustained a hip fracture within the year following the CT scan and a control group of 24 patients who did not have a hip fracture within one year. The main outcome of the CTFEA is a novel measure of hip bone strength termed the Hip Strength Score (HSS). Results The HSS was significantly lower in the study group (1.76 (SD 0.46)) than in the control group (2.31 (SD 0.74); p = 0.002). A multivariate model showed the odds of having a hip fracture were 17 times greater in patients who had an HSS ≤ 2.2. The CTFEA has a sensitivity of 89%, a specificity of 76%, and an area under the curve of 0.90. Conclusion This preliminary study demonstrates the feasibility of using a CTFEA-based bone strength parameter to assess hip fracture risk in a population of T2DM patients. Cite this article: Bone Joint J 2021;103-B(9):1497–1504.

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