Abstract
Osteoporotic vertebral fractures represent major cause of disability, loss of quality of life and even mortality among the elderly population. Decisions on drug therapy are based on the assessment of risk factors for fracture, from bone mineral density measurements. The combination of biomechanical models with clinical studies could better estimate bone strength and support the specialists in their decision. A model to assess the probability of fracture, based on the Damage and Fracture Mechanics has been developed, evaluating the mechanical magnitudes involved in the fracture process from clinical bone mineral density measurements. The model is intended for simulating the degenerative process in the skeleton, with the consequent lost of bone mass and hence the decrease of its mechanical resistance which enables the fracture due to different traumatisms. Clinical studies were chosen, both in non-treatment conditions and receiving drug therapy, and fitted to specific patients according their actual bone mineral density measures. The predictive model is applied in a finite element simulation of the lumbar spine. The fracture zone would be determined according loading scenario (fall, impact, accidental loads, etc.), using the mechanical properties of bone obtained from the evolutionary model corresponding to the considered time. Bone mineral density evolution in untreated patients and in those under different treatments was analyzed. Evolutionary curves of fracture probability were obtained from the evolution of mechanical damage. The evolutionary curve of the untreated group of patients presented a marked increase of the fracture probability, while the curves of patients under drug treatment showed variable decreased risks, depending on the therapy type. The finite element model allowed obtaining detailed maps of damage and fracture probability, identifying high-risk local zones at vertebral body, which are the usual localization of osteoporotic vertebral fractures. The developed model is suitable for being used in individualized cases. The model might better identify at-risk individuals in early stages of osteoporosis and might be helpful for treatment decisions.
Highlights
Osteoporotic fractures represent major cause of disability, loss of quality of life and even death among the elderly population [1]
Osteoporosis is caused by a skeletal involution linked to aging, which is more prevalent in women: the lifetime risk for a fragility fracture at the age of 50 lies within the range of 40% in women [2]
Underdiagnosis of osteoporotic vertebral fracture is common for the lack of complementary tests in older women who visit the doctor complaining of back pain and sometimes because the symptomatology of the first fracture is not evident [7] [8]
Summary
Osteoporotic fractures represent major cause of disability, loss of quality of life and even death among the elderly population [1]. Osteoporosis is caused by a skeletal involution linked to aging, which is more prevalent in women: the lifetime risk for a fragility fracture at the age of 50 lies within the range of 40% in women [2]. Vertebral fracture is the most common osteoporotic fracture, being more prevalent in women than in men [3] [4], leading to back pain, kyphosis and severe functional and vital impact in 30% - 50% of patients [5] [6]. Underdiagnosis of osteoporotic vertebral fracture is common for the lack of complementary tests in older women who visit the doctor complaining of back pain and sometimes because the symptomatology of the first fracture is not evident [7] [8]. The first vertebral fracture is a factor of high risk of new fractures, localized in another vertebra or other areas of skeleton [11]-[15], leading to so-called fracture cascade [16], when new fractures occur in the spine
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