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Effect of finite element model loading condition on fracture risk assessment in men and women: The AGES-Reykjavik study

Keyak, J. H.; Sigurdsson, S.; Karlsdottir, G. S.; Oskarsdottir, D.; Sigmarsdottir, A.; Kornak, J.; Harris, T. B.; Sigurdsson, G.; Jönsson, Bo LU and Siggeirsdottir, K., et al. (2013) In Bone 57(1). p.18-29
Abstract
Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4-7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls... (More)
Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4-7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls from a pool of age- and sex-matched subjects. From the QCT data, FE models employing nonlinear material properties computed FE-strength of the left hip of each subject in loading from a fall onto the posterolateral (F-PL), posterior (F-P) and lateral (F-L) aspects of the greater trochanter (patent pending). For comparison, FE strength in stance loading (F-Stance) and total femur areal bone mineral density (aBMD) were also computed. For all loading conditions, the reductions in strength associated with fracture in men were more than twice those in women (p <= 0.01). For fall loading specifically, posterolateral loading in men and posterior loading in women were most strongly associated with incident hip fracture. After adjusting for aBMD, the association between F-P and fracture in women fell short of statistical significance (p = 0.08), indicating that FE strength provides little advantage over aBMD for identifying female hip fracture subjects. However, in men, after controlling for aBMD, F-PL was 424 N (11%) less in subjects with fractures than in controls (p = 0.003). Thus, in men, FE models of posterolateral loading include information about incident hip fracture beyond that in aBMD. (c) 2013 Elsevier Inc. All rights reserved. (Less)
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keywords
Hip fracture, Femur, Bone strength, Finite element analysis, Osteoporosis, Quantitative computed tomography
in
Bone
volume
57
issue
1
pages
18 - 29
publisher
Elsevier
external identifiers
  • wos:000325742600003
  • scopus:84883288944
ISSN
1873-2763
DOI
10.1016/j.bone.2013.07.028
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English
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yes
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937fe13a-e264-45d7-bef6-12d968a00241 (old id 4157956)
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2013-12-02 10:43:40
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2018-03-18 03:57:14
@article{937fe13a-e264-45d7-bef6-12d968a00241,
  abstract     = {Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4-7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls from a pool of age- and sex-matched subjects. From the QCT data, FE models employing nonlinear material properties computed FE-strength of the left hip of each subject in loading from a fall onto the posterolateral (F-PL), posterior (F-P) and lateral (F-L) aspects of the greater trochanter (patent pending). For comparison, FE strength in stance loading (F-Stance) and total femur areal bone mineral density (aBMD) were also computed. For all loading conditions, the reductions in strength associated with fracture in men were more than twice those in women (p &lt;= 0.01). For fall loading specifically, posterolateral loading in men and posterior loading in women were most strongly associated with incident hip fracture. After adjusting for aBMD, the association between F-P and fracture in women fell short of statistical significance (p = 0.08), indicating that FE strength provides little advantage over aBMD for identifying female hip fracture subjects. However, in men, after controlling for aBMD, F-PL was 424 N (11%) less in subjects with fractures than in controls (p = 0.003). Thus, in men, FE models of posterolateral loading include information about incident hip fracture beyond that in aBMD. (c) 2013 Elsevier Inc. All rights reserved.},
  author       = {Keyak, J. H. and Sigurdsson, S. and Karlsdottir, G. S. and Oskarsdottir, D. and Sigmarsdottir, A. and Kornak, J. and Harris, T. B. and Sigurdsson, G. and Jönsson, Bo and Siggeirsdottir, K. and Eiriksdottir, G. and Gudnason, V. and Lang, T. F.},
  issn         = {1873-2763},
  keyword      = {Hip fracture,Femur,Bone strength,Finite element analysis,Osteoporosis,Quantitative computed tomography},
  language     = {eng},
  number       = {1},
  pages        = {18--29},
  publisher    = {Elsevier},
  series       = {Bone},
  title        = {Effect of finite element model loading condition on fracture risk assessment in men and women: The AGES-Reykjavik study},
  url          = {http://dx.doi.org/10.1016/j.bone.2013.07.028},
  volume       = {57},
  year         = {2013},
}