Abstract
Osteoporotic fracture incidence represents a major social and economic concern in the modern society, where the progressive graying of the population involves an highly increased fracture occurrence. Although the gold standard to diagnose osteoporosis is represented by the T-score measurement, estimated from the Bone Mineral Density (BMD) using Dual-energy X-ray Absorptiometry (DXA), the identification of the subjects at high risk of fracture still remains an issue. From this perspective, the purpose of this work is to investigate the role that DXA-based two-dimensional patient-specific finite element (FE) models of the proximal femur, in combination with T-score, could play in enhancing the risk of fracture estimation. With this aim, 2D FE models were built from DXA images of the 28 post-menopausal female subjects involved. A sideways fall condition was reproduced and a Risk of Fracture () was computed on the basis of principal strains criteria. The identified was then compared to that derived from the CT-based models developed in a previous study. The 2D and 3D turned out to be significantly correlated (Spearman's ρ = 0.66, p < 0.001), highlighting the same patients as those at higher risk. Moreover, the 2D resulted significantly correlated with the T-score (Spearman's ρ = −0.69, p < 0.001), and managed to better differentiate osteopenic patients, drawing the attention to some of them. The Hip Structural Analysis (HSA) variables explaining the majority of the variance of the 2D and 3D fracture risk were the same as well, i.e., neck-shaft angle and narrow neck buckling ratio. In conclusion, DXA-based FE models, developable from currently available clinical data, appear promising in supporting and integrating the present diagnostic procedure.
Highlights
During the last decades osteoporotic fractures have grown into a major healthcare concern, especially in western countries
Loss of mechanical strength associated to the onset of osteoporosis predisposes the proximal femur to fracture, it is still not trivial to interpret the physiopathology of osteoporotic fractures, which represent complex multifactorial events
Aiming to get further insights in the role 2D finite element (FE) simulations might play, the main purpose of the study was the comparison between the predictions, in terms of risk of fracture, derived from the CT (Aldieri et al, 2018) and Dual-energy X-ray Absorptiometry (DXA) FE models
Summary
During the last decades osteoporotic fractures have grown into a major healthcare concern, especially in western countries. In Europe, 30% of Fracture Prediction Through DXA-Derived FEM women over 50 years are affected by osteoporosis (Melton et al, 1992; Kanis et al, 2000; Hernlund et al, 2013) and that in 2000 the number of osteoporotic fractures was 3.1–3.7 million, with a direct cost of 32 billion (Kanis and Johnell, 2005). These costs are expected to raise to more than double by 2050 (Kanis and Johnell, 2005). Loss of mechanical strength associated to the onset of osteoporosis predisposes the proximal femur to fracture, it is still not trivial to interpret the physiopathology of osteoporotic fractures, which represent complex multifactorial events
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