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3d Finite Element Models Reconstructed From 2d Dxa Images Improve Hip Fracture Prediction Compared to Areal Bmd in Mros Sweden Cohort

Grassi, Lorenzo LU orcid ; Väänänen, Sami P ; Jehpsson, Lars LU ; Ljunggren, Östen ; Rosengren, Björn E LU ; Karlsson, Magnus K LU and Isaksson, Hanna LU orcid (2023) In Journal of Bone and Mineral Research 38(9). p.1258-1267
Abstract

Bone strength is an important contributor to fracture risk. Areal bone mineral density (aBMD) derived from dual-energy X-ray absorptiometry (DXA) is used as a surrogate for bone strength in fracture risk prediction tools. 3D finite element (FE) models predict bone strength better than aBMD, but their clinical use is limited by the need for 3D computed tomography and lack of automation. We have earlier developed a method to reconstruct the 3D hip anatomy from a 2D DXA image, followed by subject-specific FE-based prediction of proximal femoral strength. In the current study, we aim to evaluate the method's ability to predict incident hip fractures in a population-based cohort (MrOS Sweden). We defined two sub-cohorts: (i) hip fracture... (More)

Bone strength is an important contributor to fracture risk. Areal bone mineral density (aBMD) derived from dual-energy X-ray absorptiometry (DXA) is used as a surrogate for bone strength in fracture risk prediction tools. 3D finite element (FE) models predict bone strength better than aBMD, but their clinical use is limited by the need for 3D computed tomography and lack of automation. We have earlier developed a method to reconstruct the 3D hip anatomy from a 2D DXA image, followed by subject-specific FE-based prediction of proximal femoral strength. In the current study, we aim to evaluate the method's ability to predict incident hip fractures in a population-based cohort (MrOS Sweden). We defined two sub-cohorts: (i) hip fracture cases and controls cohort: 120 men with a hip fracture (<10 years from baseline) and 2 controls to each hip fracture case, matched by age, height, and body mass index; (ii) fallers cohort: 86 men who had fallen the year before their hip DXA scan was acquired, 15 of which sustained a hip fracture during the following 10 years. For each participant, we reconstructed the 3D hip anatomy and predicted proximal femoral strength in 10 sideways fall configurations using FE analysis. The FE-predicted proximal femoral strength was a better predictor of incident hip fractures than aBMD for both hip fracture cases and controls (difference in area under the receiver operating characteristics curve, ΔAUROC = 0.06) and fallers (ΔAUROC = 0.22) cohorts. This is the first time that FE models outperform aBMD in predicting incident hip fractures in a population-based prospectively followed cohort based on 3D FE models obtained from a 2D DXA scan. Our approach has potential to notably improve the accuracy of fracture risk predictions 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
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Bone and Mineral Research
volume
38
issue
9
pages
1258 - 1267
publisher
Wiley-Blackwell
external identifiers
  • scopus:85167358801
  • pmid:37417707
ISSN
1523-4681
DOI
10.1002/jbmr.4878
language
English
LU publication?
yes
additional info
This article is protected by copyright. All rights reserved.
id
d25ed3ad-8116-4b35-b9d8-906c3868143c
date added to LUP
2023-07-14 07:16:44
date last changed
2024-04-20 01:57:48
@article{d25ed3ad-8116-4b35-b9d8-906c3868143c,
  abstract     = {{<p>Bone strength is an important contributor to fracture risk. Areal bone mineral density (aBMD) derived from dual-energy X-ray absorptiometry (DXA) is used as a surrogate for bone strength in fracture risk prediction tools. 3D finite element (FE) models predict bone strength better than aBMD, but their clinical use is limited by the need for 3D computed tomography and lack of automation. We have earlier developed a method to reconstruct the 3D hip anatomy from a 2D DXA image, followed by subject-specific FE-based prediction of proximal femoral strength. In the current study, we aim to evaluate the method's ability to predict incident hip fractures in a population-based cohort (MrOS Sweden). We defined two sub-cohorts: (i) hip fracture cases and controls cohort: 120 men with a hip fracture (&lt;10 years from baseline) and 2 controls to each hip fracture case, matched by age, height, and body mass index; (ii) fallers cohort: 86 men who had fallen the year before their hip DXA scan was acquired, 15 of which sustained a hip fracture during the following 10 years. For each participant, we reconstructed the 3D hip anatomy and predicted proximal femoral strength in 10 sideways fall configurations using FE analysis. The FE-predicted proximal femoral strength was a better predictor of incident hip fractures than aBMD for both hip fracture cases and controls (difference in area under the receiver operating characteristics curve, ΔAUROC = 0.06) and fallers (ΔAUROC = 0.22) cohorts. This is the first time that FE models outperform aBMD in predicting incident hip fractures in a population-based prospectively followed cohort based on 3D FE models obtained from a 2D DXA scan. Our approach has potential to notably improve the accuracy of fracture risk predictions 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 Jehpsson, Lars and Ljunggren, Östen and Rosengren, Björn E and Karlsson, Magnus K and Isaksson, Hanna}},
  issn         = {{1523-4681}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{9}},
  pages        = {{1258--1267}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Bone and Mineral Research}},
  title        = {{3d Finite Element Models Reconstructed From 2d Dxa Images Improve Hip Fracture Prediction Compared to Areal Bmd in Mros Sweden Cohort}},
  url          = {{http://dx.doi.org/10.1002/jbmr.4878}},
  doi          = {{10.1002/jbmr.4878}},
  volume       = {{38}},
  year         = {{2023}},
}