Prediction of proximal femur fracture risk from DXA images based on novel fracture indexes

Abstract

ABSTRACT Background: Osteoporosis is the degradation of bone microstructure that increase proximal femur risk of fracture. Current fracture prediction methods are based on the analysis of bone mineral density (BMD). Nevertheless, it has been shown that BMD alone cannot predict with certainty who will have a future hip fracture. The aim of this study was to develop a novel proximal femur fracture index approach including patient-specific geometrical and mechanical properties data to assess the femoral neck fracture risk. Methods: The patient-specific femoral neck geometry and data for the analysis were obtained from DXA scans. The fracture index was built based on a mechanical description of the fracture occurrence under a side fall impact. Results: The current approach predicts with a very good accuracy the fracture risk (TPR = 78%, TNR = 81%) and provided a good agreement with the experimental data, while the DXA-based BMD was less accurate (TPR = 60%, TNR = 56). Our predicted results showed that the proposed bone fracture index, may provide an enhanced diagnostic of proximal fracture risk diagnostic. Conclusions: The index developed here may be used in clinical applications as an enhanced tool to predict fracture risk and contribute to osteoporosis diagnosis based on DXA.