Format

Send to

Choose Destination
J Clin Densitom. 2019 Feb 8. pii: S1094-6950(18)30281-6. doi: 10.1016/j.jocd.2019.02.001. [Epub ahead of print]

Fracture Risk Indices From DXA-Based Finite Element Analysis Predict Incident Fractures Independently From FRAX: The Manitoba BMD Registry.

Author information

1
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: bleslie@sbgh.mb.ca.
2
Department of Mechanical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada.
3
Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Biomedical Engineering, Polytech Marseille, Marseille, France.
4
Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.
5
Department of Biomedical Engineering, Polytech Marseille, Marseille, France.

Abstract

OBJECTIVE:

Finite element analysis (FEA) is a computational method to predict the behavior of materials under applied loading. We developed a software tool that automatically performs FEA on dual-energy X-ray absorptiometry hip scans to generate site-specific fracture risk indices (FRIs) that reflect the likelihood of hip fracture from a sideways fall. This longitudinal study examined associations between FRIs and incident fractures.

METHODS:

Using the Manitoba Bone Mineral Density (BMD) Registry, femoral neck (FN), intertrochanter (IT), and subtrochanter (ST) FRIs were automatically derived from 13,978 anonymized dual-energy X-ray absorptiometry scans (Prodigy, GE Healthcare) in women and men aged 50 yr or older (mean age 65 yr). Baseline covariates and incident fractures were assessed from population-based data. We compared c-statistics for FRIs vs FN BMD alone and fracture risk assessment (FRAX) probability computed with BMD. Cox regression was used to estimate hazard ratios and 95% confidence intervals (95% CIs) for incident hip, major osteoporotic fracture (MOF) and non-hip MOF adjusted for relevant covariates including age, sex, FN BMD, FRAX probability, FRAX risk factors, and hip axis length (HAL).

RESULTS:

During mean follow-up of 6 yr, there were 268 subjects with incident hip fractures, 1003 with incident MOF, and 787 with incident non-hip MOF. All FRIs gave significant stratification for hip fracture (c-statistics FN-FRI: 0.76, 95% CI 0.73-0.79, IT-FRI 0.74, 0.71-0.77; ST-FRI 0.72, 0.69-0.75). FRIs continued to predict hip fracture risk even after adjustment for age and sex (hazard ratio per standard deviation FN-FRI 1.89, 95% CI 1.66-2.16); age, sex, and BMD (1.26, 1.07-1.48); FRAX probability (1.30, 1.11-1.52); FRAX probability with HAL (1.26, 1.05-1.51); and individual FRAX risk factors (1.32, 1.09-1.59). FRIs also predicted MOF and non-hip MOF, but the prediction was not as strong as for hip fracture.

SUMMARY:

Automatically-derived FN, IT, and ST FRIs are associated with incident hip fracture independent of multiple covariates, including FN BMD, FRAX probability and risk factors, and HAL.

KEYWORDS:

Dual-energy X-ray absorptiometry; FRAX; finite element analysis; fracture risk; hip fracture; osteoporosis

PMID:
30852033
DOI:
10.1016/j.jocd.2019.02.001

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center