Are CT-Based Finite Element Model Predictions Of Femoral Bone Strengthening Clinically Useful?
M. Viceconti, M. Qasim, P. Bhattacharya, X. Li
Published 2018 · Medicine
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Purpose of ReviewThis study reviews the available literature to compare the accuracy of areal bone mineral density derived from dual X-ray absorptiometry (DXA-aBMD) and of subject-specific finite element models derived from quantitative computed tomography (QCT-SSFE) in predicting bone strength measured experimentally on cadaver bones, as well as their clinical accuracy both in terms of discrimination and prediction. Based on this information, some basic cost-effectiveness calculations are performed to explore the use of QCT-SSFE instead of DXA-aBMD in (a) clinical studies with femoral strength as endpoint, (b) predictor of the risk of hip fracture in low bone mass patients.Recent FindingsRecent improvements involving the use of smooth-boundary meshes, better anatomical referencing for proximal-only scans, multiple side-fall directions, and refined boundary conditions increase the predictive accuracy of QCT-SSFE.SummaryIf these improvements are adopted, QCT-SSFE is always preferable over DXA-aBMD in clinical studies with femoral strength as the endpoint, while it is not yet cost-effective as a hip fracture risk predictor, although pathways that combine both QCT-SSFE and DXA-aBMD are promising.
This paper references
Assessment of the strength of proximal femur in vitro: relationship to femoral bone mineral density and femoral geometry.
X. Cheng (1997)
Association of incident hip fracture with the estimated femoral strength by finite element analysis of DXA scans in the Osteoporotic Fractures in Men (MrOS) study
L. Yang (2017)
Effect of finite element model loading condition on fracture risk assessment in men and women: the AGES-Reykjavik study.
J. Keyak (2013)
Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women.
S. Cummings (1989)
Risk of fracture in elderly patients: a new predictive index based on bone mineral density and finite element analysis.
D. Testi (1999)
Costeffectiveness of virtual bone strength testing in osteoporosis screening programs for postmenopausal women
CA •• Agten (2017)
Patient-specific finite element estimated femur strength as a predictor of the risk of hip fracture: the effect of methodological determinants
M. Qasim (2016)
A comparative study on different methods of automatic mesh generation of human femurs.
M. Viceconti (1998)
Response to questions regarding conclusions reached in “Age dependence of femoral strength in white women and men”
T. M. Keaveny (2010)
Impact of hip fracture on hospital care costs: a population-based study
J. Leal (2015)
Cost-effectiveness of Virtual Bone Strength Testing in Osteoporosis Screening Programs for Postmenopausal Women in the United States.
C. Agten (2017)
Robust QCT/FEA Models of Proximal Femur Stiffness and Fracture Load During a Sideways Fall on the Hip
D. Dragomir-Daescu (2010)
The weight of nations: an estimation of adult human biomass
S. Walpole (2012)
Left–right differences in the proximal femur’s strength of post-menopausal women: a multicentric finite element study
F. Taddei (2015)
Comparative Effectiveness of Pharmacologic Treatments to Prevent Fractures
C. Crandall (2014)
Influence of Smoothing on Voxel-Based Mesh Accuracy in Micro-Finite Element
T. Bardyn (2010)
Bending strength of the femur in relation to non-invasive bone mineral assessment.
K. Strømsøe (1995)
QCT/FEA predictions of femoral stiffness are strongly affected by boundary condition modeling
T. Rossman (2016)
particular interest, published recently, have been highlighted as: •• Of major importance
Overview of Fracture Prediction Tools.
J. Kanis (2017)
A nonlinear QCT-based finite element model validation study for the human femur tested in two configurations in vitro.
E. Dallara (2013)
Classification of women with and without hip fracture based on quantitative computed tomography and finite element analysis
K. Nishiyama (2013)
Hip Fracture in Women Without Osteoporosis
B. Clarke (2006)
Male-female differences in the association between incident hip fracture and proximal femoral strength: a finite element analysis study.
J. Keyak (2011)
Impact of Hip and Vertebral Fractures on Quality-Adjusted Life Years
A. Tosteson (2001)
Assessment of incident spine and hip fractures in women and men using finite element analysis of CT scans.
D. Kopperdahl (2014)
Multiple loading conditions analysis can improve the association between finite element bone strength estimates and proximal femur fractures: a preliminary study in elderly women.
C. Falcinelli (2014)
Volumetric quantitative computed tomography of the proximal femur: relationships linking geometric and densitometric variables to bone strength. Role for compact bone
V. Bousson (2006)
Effects of dose reduction on bone strength prediction using finite element analysis
D. Anitha (2016)
This study confirms the results of reference #11, and includes some additional methodological improvements when only proximal femur CT are available
M •• Qasim (2016)
A novel approach to estimate trabecular bone anisotropy using a database approach.
Javad Hazrati Marangalou (2013)
To what extent can linear finite element models of human femora predict failure under stance and fall loading configurations?
E. Schileo (2014)
In vivo discrimination of hip fracture with quantitative computed tomography: results from the prospective European Femur Fracture Study (EFFECT).
V. Bousson (2011)
National Institute for Health and Clinical Excellence (NICE) Guideline N. 124. The Management of Hip Fracture in Adults. London: Royal College of Physicians (UK)
Distribution of bone density and cortical thickness in the proximal femur and their association with hip fracture in postmenopausal women: a quantitative computed tomography study
L. Yang (2013)
Prediction of Hip Failure Load: In Vitro Study of 80 Femurs Using Three Imaging Methods and Finite Element Models-The European Fracture Study (EFFECT).
P. Pottecher (2016)
Age-Dependence of Femoral Strength in White Women and Men
T. M. Keaveny (2010)
An accurate estimation of bone density improves the accuracy of subject-specific finite element models.
E. Schileo (2008)
Hip fracture in women without osteoporosis.
Stacey A Wainwright (2005)
mineral density and femoral geometry
F Eckstein (1997)
3-D femoral stress analysis using CT scans and p-version FEM.
P. K. Basu (1985)
Comparison of non-invasive assessments of strength of the proximal femur.
F. Johannesdottir (2017)
Bone strength at clinically relevant sites displays substantial heterogeneity and is best predicted from site-specific bone densitometry.
F. Eckstein (2002)
Comparison of proximal femur and vertebral body strength improvements in the FREEDOM trial using an alternative finite element methodology.
Philippe K Zysset (2015)
Biomechanical Role of Bone Anisotropy Estimated on Clinical CT Scans by Image Registration
E. Taghizadeh (2016)
Clinical Use of Quantitative Computed Tomography-Based Finite Element Analysis of the Hip and Spine in the Management of Osteoporosis in Adults: the 2015 ISCD Official Positions-Part II.
P. Zysset (2015)
Clinical pathway for osteoporotic hip fracture risk assessment using patient-specific finite element models
M Qasim (2017)
Finite element analysis of the proximal femur and hip fracture risk in older men.
E. Orwoll (2009)
This paper is referenced by
FROM BED TO BENCH: HOW IN SILICO MEDICINE CAN HELP AGEING RESEARCH
Marco Viceconti (2018)
Cost-Effectiveness of Osteoporosis Screening Using Biomechanical Computed Tomography for Patients With a Previous Abdominal CT.
M. Pisu (2019)
The influence of anisotropic voxel caused by field of view setting on the accuracy of three-dimensional reconstruction of bone geometric models
Yaming Liu (2018)
Effect of CT imaging on the accuracy of the finite element modelling in bone
E. Benca (2020)
Radiofrequency echographic multi-spectrometry for the in-vivo assessment of bone strength: state of the art—outcomes of an expert consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)
Adolfo Diez-Perez (2019)
Microindentation: A New Technique for Bone Quality Assessment.
Diana Ovejero Crespo (2020)
Prediction of fracture risk of a distal femur reconstructed with bone cement: QCSRA, FEA, and in-vitro cadaver tests
Hoda Mosleh (2020)
Biomechanical Computed Tomography analysis (BCT) for clinical assessment of osteoporosis
T.M. Keaveny (2020)
The role of microstructure for crack propagation in cortical bone
Anna Gustafsson (2019)
Fracture Risk Assessment and Clinical Decision Making for Patients with Metastatic Bone Disease.
Timothy A Damron (2020)
Prediction of The Strength of Human Long Bone Using CT Based Finite Element Method
Z. Altai (2018)
The effect of boundary and loading conditions on patient classification using finite element predicted risk of fracture.
Zainab Altai (2019)
Neuro-musculoskeletal flexible multibody simulation yields a framework for efficient bone failure risk assessment
Andreas Geier (2019)
Predicting bone strength from CT data: Clinical applications.
Marco Viceconti (2019)
Microindentation: A New Technique for Bone Quality Assessment
Diana Ovejero Crespo (2020)
High- and low-viscosity cement for osteoporotic femoral augmentation: A computational subject-specific approach
Samuel Jesús Ramos-Infante (2019)
A multiscale model to predict current absolute risk of femoral fracture in a postmenopausal population
P. Bhattacharya (2019)