Osteoporotic Hip Fracture Prediction: Is T-Score-Based Criterion Enough? A Hip Structural Analysis-Based Model

2018 ◽  
Vol 140 (11) ◽  
Author(s):  
Alessandra Aldieri ◽  
Mara Terzini ◽  
Giangiacomo Osella ◽  
Adriano M. Priola ◽  
Alberto Angeli ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Structural Analysis ◽  
Fracture Risk ◽  
Proximal Femur ◽  
Patient Specific ◽  
Multivariate Linear Regression Analysis ◽  
Hip Structural Analysis ◽  
Mineral Density ◽  
Neck Shaft Angle ◽  
Adopted Model

At present, the current gold-standard for osteoporosis diagnosis is based on bone mineral density (BMD) measurement, which, however, has been demonstrated to poorly estimate fracture risk. Further parameters in the hands of the clinicians are represented by the hip structural analysis (HSA) variables, which include geometric information of the proximal femur cross section. The purpose of this study was to investigate the suitability of HSA parameters as additional hip fracture risk predictors. With this aim, twenty-eight three-dimensional patient-specific models of the proximal femur were built from computed tomography (CT) images and a sideways fall condition was reproduced by finite element (FE) analyses. A tensile or compressive predominance based on minimum and maximum principal strains was determined at each volume element and a risk factor (RF) was calculated. The power of HSA variables combinations to predict the maximum superficial RF values was assessed by multivariate linear regression analysis. The optimal regression model, identified through the Akaike information criterion (AIC), only comprises two variables: the buckling ratio (BR) and the neck-shaft angle (NSA). In order to validate the study, the model was tested on two additional patients who suffered a hip fracture after a fall. The results classified the patients in the high risk level, confirming the prediction power of the adopted model.

Proximal femur geometry assessed by hip structural analysis in hip fracture in women

2015 ◽  
Vol 27 (S1) ◽  
pp. 17-21 ◽  
Author(s):  
Giovanni Iolascon ◽  
Antimo Moretti ◽  
Giovanni Cannaviello ◽  
Giuseppina Resmini ◽  
Francesca Gimigliano
Keyword(s):  
Hip Fracture ◽  
Structural Analysis ◽  
Proximal Femur ◽  
Hip Structural Analysis ◽  
Femur Geometry

scholarly journals POS0511 USING HIP STRUCTURAL ANALYSIS MEASUREMENTS TO PREDICT FRACTURE IN RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 488.2-489
Author(s):  
R. Ark ◽  
M. Bukhari
Keyword(s):  
Rheumatoid Arthritis ◽  
Structural Analysis ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Regression Models ◽  
Hip Structural Analysis ◽  
Odds Ratios ◽  
Mineral Density ◽  
Cross Sectional ◽  
Femur Strength Index

Background:Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease and increases the risk of developing osteoporosis. Incidence of fracture is higher in this group of patients compared to the general population and can lead to increased morbidity (1). Bone strength of the proximal femur is not only linked to bone mineral density; it also depends on the geometric properties of the bone mass (2). Hip structural analysis (HSA) is a technique used to assess hip bone structure that takes geometric measurements of the femur from dual-energy X-ray absorptiometry (DEXA) images (3).Objectives:To determine whether HSA measurements help predict fracture in patients with RA.Methods:Data were collected from June 2004 to August 2017 from RA patients who underwent a DEXA scan at a District General Hospital. This included hip axis length (HAL), cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), distance from centre of femoral head to centre of femoral neck (D1) and to inter-trochanteric line (D2), mean femoral neck diameter (D3), shaft angle (A) neck/shaft angle (Θ) and proximal femur strength index (SI) and distance from centre of mass of femoral neck to superior neck margin (Y). Fracture was predicted by a series of binomial logistic regression models, adjusted for sex, age and bone mineral density (BMD). Odds ratios with 95% confidence intervals and area under the receiver operating characteristic curve (AUC) were calculated.Results:2077 patients with RA were identified, 1632 were female and the mean age was 66.7. HAL, D1, D2, D3, A, Θ and Y were not significant predictors of fracture in regression models; odds ratios are included in table 1. CSA, CSMI and SI predicted fracture risk. The AUC for CSA, CSMI and SI regression models were 0.632, 0.609 and 0.625 respectively.Table 1.Odds ratios of fracture for different HSA parameters in RA patientsHSA ParameterOdds Ratio (95% Confidence Interval)HAL1.01410 (0.99958 - 1.02883)CSMI0.99994 (0.99990 - 0.99998)CSA0.98523 (0.98065 - 0.98982)D11.01683 (0.98925 - 1.04518)D21.01286 (0.99886 - 1.02705)D31.00664 (0.96958 - 1.04511)Y1.04580 (0.98633 - 1.10886)A1.00898 (0.98878 - 1.02959)Θ1.00276 (0.98672 - 1.01906)SI0.56769 (0.43400 - 0.74258)Figure 1.Receiver operating characteristic curves for CSA (red), CSMI (green) and SI (blue). AUC for CSA was 0.632, CSMI-0.609 and SI-0.625.Conclusion:These data suggest that CSA, CSMI and SI help predict the fracture risk in patients with RA. HAL, D1, D2, D3, A, Θ and Y do not predict risk of fracture. The CSA regression model was the strongest predictor of fracture. HSA measurements can therefore help predict risk of fracture in conjunction with other factors. Limitations of the study are that it was retrospective and only studied patients who had a DEXA scan.References:[1]Xue A, Wu S, Jiang L, Feng A, Guo H, Zhao P. Bone fracture risk in patients with rheumatoid arthritis: A meta-analysis. Medicine. 2017; 96 (36): e6983. Available from: doi: 10.1097/MD.0000000000006983.[2]Faulkner KG, Wacker WK, Barden HS, Simonelli C, Burke PK, Ragi S, Del Rio L. Femur strength index predicts hip fracture independent of bone density and hip axis length. Osteoporos Int. 2006;17(4):593-9. doi: 10.1007/s00198-005-0019-4.[3]Kaptoge S, Beck TJ, Reeve J, Stone KL, Hillier TA, Cauley JA, et al. Prediction of Incident Hip Fracture Risk by Femur Geometry Variables Measured by Hip Structural Analysis in the Study of Osteoporotic Fractures. Journal of Bone and Mineral Research. 2008; 23 (12): 1892-1904. Available from: doi: https://doi.org/10.1359/jbmr.080802.Disclosure of Interests:None declared

scholarly journals Prediction of Incident Hip Fracture Risk by Femur Geometry Variables Measured by Hip Structural Analysis in the Study of Osteoporotic Fractures

2008 ◽  
Vol 23 (12) ◽  
pp. 1892-1904 ◽  
Author(s):  
Stephen Kaptoge ◽  
Thomas J Beck ◽  
Jonathan Reeve ◽  
Katie L Stone ◽  
Teresa A Hillier ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Structural Analysis ◽  
Fracture Risk ◽  
Osteoporotic Fractures ◽  
Hip Structural Analysis ◽  
Hip Fracture Risk ◽  
Femur Geometry

scholarly journals SAT0094 ASSESMENT OF BONE MINERAL DENSITY AND FRACTURE RISK IN PATIENTS WITH RHEUMATOID ARTHRITIS AND SARCOPENIA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 980.2-981
Author(s):  
O. Dobrovolskaya ◽  
Z. Kolkhidova ◽  
A. Menshikova ◽  
N. Demin ◽  
N. Toroptsova
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Hip Fracture ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Osteoporotic Fracture ◽  
Proximal Femur ◽  
Mineral Density ◽  
Major Osteoporotic Fracture

Background:The problem of sarcopenia (SP) in rheumatoid arthritis (RA) is particularly significant in terms of assessing the risk of fractures, since SP leads to falls, which are an independent risk factor for fractures along with RA and osteoporosis.Objectives:To evaluate the bone mineral density (BMD) and fracture risk in women with RA and SP.Methods:79 women with RA based on the 2010 ACR/EULAR classification criteria were included: 20 (25%) women with confirmed SP (age median 59 [53; 64]) according to EWGSOP2 criteria and 59 (75%) women without SP (age median 60 [55; 67]) (p>0.05). We assessed clinical data: age, body mass index (BMI), disease duration, anthropometric measurements, C-reactive protein level, disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR), previous medication use including glucocorticoids and methotrexate, muscle strength and function. Dual-energy X-ray absorptiometry (DXA) to measure BMD of lumbar spine (LS), femoral neck (FN) and total hip (TH) was performed. The 10-year probability of major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture) and the 10-year probability hip fracture was calculated using the Russian version of the FRAX® tool. Statistical analysis was performed using non-parametric methods. All patients signed an informed consent to participate.Results:Median BMD in LS was 0.892 [0.772; 1.024] g/cm2in patients with SP and 0.910 [0.785; 1.028] g/cm2- without SP (p>0.05). There was significant difference between groups in the proximal femur BMD: 0.760 [0.731; 0.826] g/cm2in TH and 0.681 [0.607; 0.703] g/cm2in FN in patients with SP and 0.838 [0.735; 0.921] g/cm2in TH and 0.719 [0.622; 0.804] g/cm2in FN in patients without SP (p=0.009 and p=0.048, respectively). The frequency of osteoporosis was 35% and 22% in patients with and without SP (p>0,05). The 10-year probability of major osteoporotic fracture with / without femoral neck BMD data was 22,0% [17,0; 32,0] / 19,5% [18,5; 22,5 and 13,3% [9,8; 18,5] / 12,8% [9,3; 17,0] in patients with SP and without SP (р<0.05) and the 10-year probability of hip fracture with / without femoral neck BMD data - 3,1% [3,0; 7,5] / 3,1% [2,3; 3,3] and 1,4% [0,9; 2,78] / 0,65 [0,4; 1,7], respectively (р<0.05).Conclusion:There were no differences in the frequency of osteoporosis between patients with SP and without SP, however women with SP had proximal femur BMD less than women without SP. The probability of major osteoporotic fracture and hip fracture was significantly higher in patients with RA and SP compared with patients without SP.Disclosure of Interests:None declared

scholarly journals Ex Vivo Evaluation of Hip Fracture Risk by Proximal Femur Geometry and Bone Mineral Density in Elderly Chinese Women

2018 ◽  
Vol 24 ◽  
pp. 7438-7443 ◽  
Author(s):  
Xiao-jiang Yang ◽  
Hong-xun Sang ◽  
Bo Bai ◽  
Xiang-yu Ma ◽  
Chao Xu ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Proximal Femur ◽  
Ex Vivo ◽  
Chinese Women ◽  
Mineral Density ◽  
Elderly Chinese ◽  
Femur Geometry

scholarly journals SAT0320 BONE MINERAL DENSITY AND FRACTURE RISK IN A COHORT OF PORTUGUESE SYSTEMIC SCLEROSIS PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1105.1-1106
Author(s):  
S. Garcia ◽  
B. M. Fernandes ◽  
S. Ganhão ◽  
M. Rato ◽  
F. Pinheiro ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Systemic Sclerosis ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Vitamin D Insufficiency ◽  
Spine Fractures ◽  
Mineral Density ◽  
Portuguese Population ◽  
Cutaneous Form

Background:Although poorly understood, patients with Systemic Sclerosis (SSc) seem to have higher prevalence of low bone mineral density (BMD) and an increased spine fracture risk.Objectives:We aim to determine, by conventional densitometry (DXA) and using the fracture risk assessment tool (FRAX), the prevalence of low BMD and the fracture risk, respectively, in our SSc cohort and its potential determinants.Methods:Observational transversal study was performed including consecutive patients with the diagnosis of SSc. We collected data regarding demographics, BMD (lumbar spine and femoral neck) and occurrence of fracture. Ten-year risk of osteoporotic fracture was estimated using FRAXv4.1with the Portuguese population reference. Statistical analysis was performed using SPSS 23.0; p<0.01 was considered statistically significant.Results:Median age of patients (n=97) was 62 years old [56, 70], 88.7% females (n=86). Seventy-eight patients (80.4%) had limited cutaneous form, 5 (5.2%) presented a diffuse cutaneous form and 13 (13.4%) an overlap syndrome. Regarding clinical features: digital ulcers in 30 patients (30.9%), interstitial lung disease (ILD) in 16 (6.5%), gastrointestinal involvement in 16 (16.5%), miositis in 4 (4.1%) and pulmonary arterial hypertension in 3 (3.1%). Anti-topoisomerase I antibody (anti-Scl70) positivity was present in 15 patients (15.5%) and anti-centromere antibody (ACA) positivity in 63 (64.9%). Nine patients (9.3%) were smokers and 6 (6.2%) reported an alcohol consumption of 3 or more units/day. Median body mass index (BMI) was 25.4 Kg/m2[21.4, 29.1], with 5 patients (5.2%) being underweight. Vitamin D insufficiency was reported in 19 patients (19.6%). Twenty-one patients (21.6%) have been exposed to oral glucocorticoids (GCT) for more than 3 months at a dose of 5mg daily or more. Eleven patients (11.3%) had previous low impact fractures: 10 of which were vertebral and 1 wrist fracture. Regarding the prescribed anti-osteoporotic treatment (AOP), we found: alendronate (n=7, 7.2%), zoledronic acid (n=7, 7.2%), denosumab (n=2, 2.1%) and teriparatide (n=1, 1%).Low BMD was present in 45 patients (46.4%); median femoral neck BMD (FN-BMD) was 0.827 [0.709, 0.893].Ten year probability of fracture (%) was: median risk for major fracture was 5.1 [3.5, 9.7] and 3.8 [2.5, 8], with and without FN-BMD, respectively; for hip fracture the estimated risk was 1.2 [0.6, 3.1] and 1.0 [0.4, 2.5], with and without FN-BMD, respectively. According to FRAX thresholds for the Portuguese population, 25 patients (25.8%) met criteria to start AOP treatment. Among them, only 10 patients (40%) started it, as the agreement between the indication to treat by FRAX and the onset of treatment was weak (k= 0.338). A strong agreement was found between FRAX risk threshold with DXA and World Health Organization (WHO) threshold for starting AOP (k= 0.814) and no agreement was found between FRAX risk without DXA and WHO threshold.FN-BMD presented a weak correlation with BMI (r = 0.393), a moderate inverse correlation with major fracture risk with and without FN-BMD (r = -0.704, r=-0.412, respectively) and with hip fracture risk with and without FN-BMD (r = -0.799, r=-0.412, respectively). Major fracture risk with and without FN-BMD presented a moderate correlation with spine fractures (r = 0.350; r=0.397, respectively).No correlation was found between WHO threshold and spine fractures. No correlations were found between FN-BMD or fracture risk estimated by FRAX and disease manifestations, anti-Scl70 or ACA positivity, vitamin D insufficiency, smoking or GCT use.Conclusion:In our cohort, low BMD was prevalent and had correlation with BMI. FRAX appears to be an useful instrument as it correlated with spine fractures, contrary to what was verified when we used the WHO threshold. Early monitoring of BMD and estimating fracture risk using FRAX appear to be useful tools for the prevention of fractures in this population.Disclosure of Interests:Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Sara Ganhão: None declared, Maria Rato: None declared, Filipe Pinheiro: None declared, Georgina Terroso: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

Effect of Loading Direction and Bone Density Distribution in Assessing Hip Fracture via Finite Element Analysis

2020 ◽  
Author(s):  
Rabina Awal ◽  
Tanvir R. Faisal
Keyword(s):  
Hip Fracture ◽  
Bone Density ◽  
Fracture Risk ◽  
Risk Index ◽  
Transverse Plane ◽  
Coronal Plane ◽  
Mineral Density ◽  
Femoral Neck Axis ◽  
Loading Direction ◽  
The Impact

Abstract An accurate assessment of hip fracture risk requires a proper consideration of parameters affecting the fracture. In general, hip fracture is affected by bone morphology, bone mineral Density (BMD), and load amount. Hip fracture is an outcome of the interaction of all those parameters including loading directions. Assessing the effect of the parameters individually may not correctly reflect the root cause of the hip fracture. Hence, this research aims at analyzing the significance of parameters and their interaction. A multivariate regression model was used considering bone density (ρash), different loading directions during sideways fall, represented by load angle (α) on the coronal plane and angle (β) on the transverse plane as independent parameters and Fracture Risk Index (FRI) as a dependent parameter. The statistical results showing the significant value of 0.7321 for α, and 0.0001 for β and ρash indicates that the effect of loading direction about femoral shaft on the coronal plane (α) does not have impact on fracture risk while loading direction about femoral neck axis on the transverse plane (β) and ρash have the significant impact. Furthermore, the analysis of the interaction of parameters shows that the impact of β on fracture risk may depends more on bone density as the significance of interaction of β and ρash is 0.0001.

scholarly journals Hip Structural Analysis Reveals Impaired Hip Geometry in Girls With Type 1 Diabetes

2020 ◽  
Vol 105 (12) ◽  
pp. e4848-e4856
Author(s):  
Taïsha V Joseph ◽  
Signe Caksa ◽  
Madhusmita Misra ◽  
Deborah M Mitchell
Keyword(s):  
Type 1 Diabetes ◽  
Hip Fracture ◽  
Structural Analysis ◽  
Bone Age ◽  
Sectional Area ◽  
Hip Structural Analysis ◽  
Hip Geometry ◽  
Cross Sectional ◽  
Skeletal Fragility

Abstract Context Among patients with type 1 diabetes (T1D), the risk of hip fracture is up to 6-fold greater than that of the general population. However, the cause of this skeletal fragility remains poorly understood. Objective To assess differences in hip geometry and imaging-based estimates of bone strength between youth with and without T1D using dual-energy x-ray absorptiometry (DXA)-based hip structural analysis. Design Cross-sectional comparison. Participants Girls ages 10 to 16 years, including n = 62 with T1D and n = 61 controls. Results The groups had similar age, bone age, pubertal stage, height, lean mass, and physical activity. Bone mineral density at the femoral neck and total hip did not differ in univariate comparisons but was lower at the femoral neck in T1D after adjusting for bone age, height, and lean mass. Subjects with T1D had significantly lower cross-sectional area, cross-sectional moment of inertia, section modulus, and cortical thickness at the narrow neck, with deficits of 5.7% to 10.3%. Cross-sectional area was also lower at the intertrochanteric region in girls with T1D. Among those T1D subjects with HbA1c greater than the cohort median of 8.5%, deficits in hip geometry and strength estimates were more pronounced. Conclusions DXA-based hip structural analysis revealed that girls with T1D have unfavorable geometry and lower estimates of bone strength at the hip, which may contribute to skeletal fragility and excess hip fracture risk in adulthood. Higher average glycemia may exacerbate effects of T1D on hip geometry.

scholarly journals Weight loss since early adulthood, later life risk of fracture hospitalizations, and bone mineral density: a prospective cohort study of 0.5 million Chinese adults

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zewei Shen ◽  
◽  
Canqing Yu ◽  
Yu Guo ◽  
Zheng Bian ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Weight Loss ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Early Adulthood ◽  
Broadband Ultrasound Attenuation ◽  
Later Life ◽  
Mineral Density

Abstract Summary In a Chinese population from both urban and rural areas, weight loss of ≥ 5 kg from early adulthood to midlife was associated with a higher risk of hip fracture and lower BMD in later life. Introduction This study investigates the association of the long-term weight loss from young adulthood through the middle ages with the subsequent 10-year risk of hospitalized fracture and calcaneus bone mineral density (BMD). Methods China Kadoorie Biobank (CKB) was established during 2004–2008 in ten areas across China. Weight at age 25 years was self-reported at baseline, and weight at baseline and resurvey was measured by the calibrated equipment. Outcomes were hospitalized fracture during follow-up and calcaneus BMD measured at resurvey. Analysis for fracture risk included 411,812 participants who were free of fracture in the last 5 years before baseline, cancer, or stroke at any time before baseline. Analysis for BMD included 21,453 participants who participated in the resurvey of 2013–2014 with the same exclusion criteria as above. Results The mean age was 50.8 at baseline and 58.4 at resurvey. Median weight change from age 25 to baseline was 4.4 kg, with 20.7% losing weight and 58.5% gaining weight. During a median follow-up of 10.1 years, we documented 13,065 cases of first diagnosed fracture hospitalizations, including 1222 hip fracture. Compared with participants whose weight was stable (± 2.4 kg), the adjusted hazard ratios (95% CIs) for those with weight loss of ≥ 5.0 kg from age 25 to baseline was 1.39 (1.17 to 1.66) for hip fracture. Weight loss was not associated with fracture risk at other sites. Those with weight loss from age 25 to resurvey had the lowest BMD measures, with β (95% CIs) of − 4.52 (− 5.08 to − 3.96) for broadband ultrasound attenuation (BUA), − 4.83 (− 6.98, − 2.67) for speed of sound (SOS), and − 4.36 (− 5.22, − 3.49) for stiffness index (SI). Conclusions Weight loss from early adulthood to midlife was associated with a higher risk of hip fracture and lower BMD in later life.

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