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DXA-based 3D finite element models predict hip fractures better than areal BMD in elderly women

Grassi, Lorenzo LU orcid ; Väänänen, Sami P. ; Voss, Antti ; Nissinen, Tomi ; Sund, Reijo ; Kröger, Heikki and Isaksson, Hanna LU orcid (2025) In Bone 195.
Abstract

Bone strength is a major contributor to fracture risk. Areal bone mineral density (aBMD) obtained from dual-energy X-ray absorptiometry (DXA) is used as a surrogate for bone strength in fracture risk prediction. 3D finite element (FE) models predict bone strength better than aBMD but need 3D computed tomography and are not automated. We have earlier developed a method to automatically reconstruct the 3D hip anatomy from a 2D hip DXA image, followed by subject-specific FE-based prediction of proximal femoral strength. In this study, we evaluate the method's ability to predict incident hip fractures in a population-based cohort of women (OSTPRE). We used a sub-cohort including 46 cases with a hip fracture (<10 years from DXA scan) and... (More)

Bone strength is a major contributor to fracture risk. Areal bone mineral density (aBMD) obtained from dual-energy X-ray absorptiometry (DXA) is used as a surrogate for bone strength in fracture risk prediction. 3D finite element (FE) models predict bone strength better than aBMD but need 3D computed tomography and are not automated. We have earlier developed a method to automatically reconstruct the 3D hip anatomy from a 2D hip DXA image, followed by subject-specific FE-based prediction of proximal femoral strength. In this study, we evaluate the method's ability to predict incident hip fractures in a population-based cohort of women (OSTPRE). We used a sub-cohort including 46 cases with a hip fracture (<10 years from DXA scan) and 2 healthy controls to each hip fracture case, matched by age, height, and body mass index. We automatically reconstructed the 3D hip anatomy and predicted proximal femoral strength using FE analysis for all the subjects of the sub-cohort. The FE-predicted proximal femoral strength was a significantly better predictor of incident hip fractures than aBMD (difference in area under the receiver operating characteristics curve, ΔAUROC = 0.10). This is the first time that 3D FE models obtained from a 2D hip DXA scan outperform aBMD in predicting incident hip fractures in a population-based prospectively followed cohort of women. Our approach provided an improved fracture risk prediction in a clinically feasible manner (only one single DXA image is needed) and without additional costs compared to the current clinical approach.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Biomechanics, DXA, Finite element, Fracture risk assessment, Osteoporosis
in
Bone
volume
195
article number
117457
pages
7 pages
publisher
Elsevier
external identifiers
  • pmid:40086683
  • scopus:86000656991
ISSN
8756-3282
DOI
10.1016/j.bone.2025.117457
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s)
id
2bf67530-d5f9-4a8a-a900-cb3a86bce6eb
date added to LUP
2025-03-25 16:26:34
date last changed
2025-07-01 22:49:38
@article{2bf67530-d5f9-4a8a-a900-cb3a86bce6eb,
  abstract     = {{<p>Bone strength is a major contributor to fracture risk. Areal bone mineral density (aBMD) obtained from dual-energy X-ray absorptiometry (DXA) is used as a surrogate for bone strength in fracture risk prediction. 3D finite element (FE) models predict bone strength better than aBMD but need 3D computed tomography and are not automated. We have earlier developed a method to automatically reconstruct the 3D hip anatomy from a 2D hip DXA image, followed by subject-specific FE-based prediction of proximal femoral strength. In this study, we evaluate the method's ability to predict incident hip fractures in a population-based cohort of women (OSTPRE). We used a sub-cohort including 46 cases with a hip fracture (&lt;10 years from DXA scan) and 2 healthy controls to each hip fracture case, matched by age, height, and body mass index. We automatically reconstructed the 3D hip anatomy and predicted proximal femoral strength using FE analysis for all the subjects of the sub-cohort. The FE-predicted proximal femoral strength was a significantly better predictor of incident hip fractures than aBMD (difference in area under the receiver operating characteristics curve, ΔAUROC = 0.10). This is the first time that 3D FE models obtained from a 2D hip DXA scan outperform aBMD in predicting incident hip fractures in a population-based prospectively followed cohort of women. Our approach provided an improved fracture risk prediction in a clinically feasible manner (only one single DXA image is needed) and without additional costs compared to the current clinical approach.</p>}},
  author       = {{Grassi, Lorenzo and Väänänen, Sami P. and Voss, Antti and Nissinen, Tomi and Sund, Reijo and Kröger, Heikki and Isaksson, Hanna}},
  issn         = {{8756-3282}},
  keywords     = {{Biomechanics; DXA; Finite element; Fracture risk assessment; Osteoporosis}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Bone}},
  title        = {{DXA-based 3D finite element models predict hip fractures better than areal BMD in elderly women}},
  url          = {{http://dx.doi.org/10.1016/j.bone.2025.117457}},
  doi          = {{10.1016/j.bone.2025.117457}},
  volume       = {{195}},
  year         = {{2025}},
}