← Back to Search
A Two-level Subject-specific Biomechanical Model For Improving Prediction Of Hip Fracture Risk.
Masoud Nasiri Sarvi, Y. Luo
Published 2015 · Medicine
Download PDFAnalyze on Scholarcy
BACKGROUND Sideways fall-induced hip fracture is a major worldwide health problem among the elderly population. However, all existing biomechanical models for predicting hip fracture mainly consider the femur related parameters. Their accuracy is limited as hip fracture is significantly affected by loading conditions as well. The objective of this study was to develop a biomechanical model for improving assessment of hip fracture risk by subject-specific prediction of fall-induced loading conditions. METHOD All information required to construct the models was extracted from the subject's whole-body and hip medical image in order to make the models subject-specific. Fall-induced hip fracture risk for eighty clinical cases was calculated under two sets of loading conditions: subject-specific determined by the proposed model, and non-subject-specific obtained from empirical functions. The predicted hip fracture risk indices were then compared with clinical observations. FINDINGS It was found that the subject-specific prediction of fall-induced loading conditions significantly improves the hip fracture risk assessment. Consistent to the clinical observations, the fracture risk predicted by the proposed model suggested that obesity is a protective factor for hip fracture and underweight subjects are more likely to experience a hip fracture. INTERPRETATIONS This study shows that hip fracture risk is affected by a number of factors, including body weight, body height, impact force, body mass index, hip soft tissue thickness, and bone quality. The proposed model provides a comprehensive, fast, accurate, and non-expensive method for prediction of hip fracture risk which should lead to more effective prevention of hip fractures.
This paper references
Epidemiology and outcomes of osteoporotic fractures
S. Cummings (2002)
Strategies for Avoiding Hip Impact During Sideways Falls
S. Robinovitch (2003)
Effect of boundary conditions, impact loading and hydraulic stiffening on femoral fracture strength.
I. Haider (2013)
Characterizing the effective stiffness of the pelvis during sideways falls on the hip.
A. Laing (2010)
The effects of body mass index and sex on impact force and effective pelvic stiffness during simulated lateral falls.
I. Levine (2013)
Use of DXA‐based finite element analysis of the proximal femur in a longitudinal study of hip fracture
K. Naylor (2013)
Proximal femur bone strength estimated by a computationally fast finite element analysis in a sideways fall configuration.
K. Nishiyama (2013)
Study of DXA-derived lateral–medial cortical bone thickness in assessing hip fracture risk
Yujia Long (2015)
Geometric structure of the femoral neck measured using dual‐energy X‐ray absorptiometry
T. Yoshikawa (1994)
Computed Tomography — An Increasing Source of Radiation Exposure
L. Tanoue (2009)
Validated finite element models of the proximal femur using two-dimensional projected geometry and bone density
J. O. D. Buijs (2011)
Medical care of elderly patients with hip fractures.
J. Huddleston (2001)
Bone quality--the material and structural basis of bone strength and fragility.
E. Seeman (2006)
Effects of trochanteric soft tissue thickness and hip impact velocity on hip fracture in sideways fall through 3D finite element simulations.
S. Majumder (2008)
Survival experience of aged hip fracture patients.
J. Magaziner (1989)
Simulation of hip fracture in sideways fall using a 3D finite element model of pelvis-femur-soft tissue complex with simplified representation of whole body.
S. Majumder (2007)
A sideways fall and hip fracture.
P. Kannus (2006)
Active responses decrease impact forces at the hip and shoulder in falls to the side.
M. Sabick (1999)
Hip fractures in the elderly: A world-wide projection
C. Cooper (2005)
Biomechanics of Fracture: Is Bone Mineral Density Sufficient to Assess Risk?
B. Mccreadie (2000)
Advances in osteoporosis imaging.
J. Bauer (2009)
A Meta‐Analysis of the Association of Fracture Risk and Body Mass Index in Women
H. Johansson (2014)
Reducing hip fracture risk during sideways falls: evidence in young adults of the protective effects of impact to the hands and stepping.
F. Feldman (2007)
The Fallacy of BMD: A Critical Review of the Diagnostic Use of Dual X-ray Absorptiometry
S. Nielsen (2000)
aged hip fracture patients
S. Majumder (2007)
Stress and strain distribution within the intact femur: compression or bending?
M. Taylor (1996)
Comparison of hip fracture risk prediction by femoral aBMD to experimentally measured factor of risk.
B. Roberts (2010)
Osteoporotic fractures, DXA, and fracture risk assessment: meeting future challenges in the Eastern Mediterranean Region.
R. Baddoura (2011)
Ct-based finite element models can be used to estimate experimentally measured failure loads in the proximal femur.
Janne E. M. Koivumäki (2012)
Assessment: Meeting Future Challenges in the Eastern Mediterranean Region
R. Miller (2009)
Hip impact velocities and body configurations for voluntary falls from standing height.
A. J. van den Kroonenberg (1996)
Falls: Epidemiology, pathophysiology, and relationship to fracture
S. Berry (2008)
Body mass index as a predictor of fracture risk: A meta-analysis
C. Laet (2005)
Prediction of femoral impact forces in falls on the hip.
S. Robinovitch (1991)
Facial anthropometric differences among gender, ethnicity, and age groups.
Z. Zhuang (2010)
Structural patterns of the proximal femur in relation to age and hip fracture risk in women.
J. Carballido-Gamio (2013)
Femoroplasty-augmentation of mechanical properties in the osteoporotic proximal femur: a biomechanical investigation of PMMA reinforcement in cadaver bones.
P. Heini (2004)
Hip fracture risk among community-dwelling elderly people in the United States: a prospective study of physical, cognitive, and socioeconomic indicators.
Robin Taylor Wilson (2006)
Contribution of Trochanteric Soft Tissues to Fall Force Estimates, the Factor of Risk, and Prediction of Hip Fracture Risk*
M. Bouxsein (2007)
Precision study of DXA-based patient-specific finite element modeling for assessing hip fracture risk.
Y. Luo (2013)
Incidence and Economic Burden of Osteoporosis‐Related Fractures in the United States, 2005–2025
R. Burge (2007)
Force attenuation in trochanteric soft tissues during impact from a fall
S. Robinovitch (1995)
In vivo short-term precision of hip structure analysis variables in comparison with bone mineral density using paired dual-energy X-ray absorptiometry scans from multi-center clinical trials.
B. C. C. Khoo (2005)
A Subject-Specific Dynamics Model for Predicting Impact Force in Elderly Lateral Fall
Y. Luo (2013)
Body mass index as a predictor of fracture risk: A metaanalysis
S. Fujiwara (2005)
Function-based morphing methodology for parameterizing patient-specific models of human proximal femurs
Byoung-Keon Park (2014)
Robust QCT/FEA Models of Proximal Femur Stiffness and Fracture Load During a Sideways Fall on the Hip
D. Dragomir-Daescu (2010)
Epidemiology of hip fractures.
P. Kannus (1996)
Official Positions for FRAX® clinical regarding falls and frailty: can falls and frailty be used in FRAX®? From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.
T. Masud (2011)
Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements.
J. Wang (1994)
Experimental Validation of Subject-Specific Dynamics Model for Predicting Impact Force in Sideways Fall
Masoud Nasiri Sarvi (2014)
The reported research has been supported by the Natural Sciences and Engineering Council (NSERC) and the Manitoba Health Research Council (MHRC) in Canada, which are gratefully acknowledged
R. Baddoura (2011)
Fall direction, bone mineral density, and function: risk factors for hip fracture in frail nursing home elderly.
S. Greenspan (1998)
A preliminary dual-energy X-ray absorptiometry-based finite element model for assessing osteoporotic hip fracture risk
Y. Luo (2011)
Femoral geometry as a risk factor for osteoporotic hip fracture in men and women.
J. Gregory (2008)
impact velocity on hip fracture in sideways fall through 3D finite element simulations
S. Majumder (2013)
Incidence and mortality of hip fractures in the United States.
C. Brauer (2009)
Analysis of hip geometry by clinical CT for the assessment of hip fracture risk in elderly Japanese women.
M. Ito (2010)
Obesity : Preventing and managing the global epidemic
D. S. Akram (2000)
Dynamic models for sideways falls from standing height.
A. J. van den Kroonenberg (1995)
Prediction of impact force in sideways fall by image-based subject-specific dynamics model
Y. Luo (2014)
Corner detector based on global and local curvature properties
X. He (2008)
Effects of running and age-related degeneration in leg extensor muscles on recovery behaviour after a fall
K. Karamanidis (2006)
The measurement of body segment inertial parameters using dual energy X-ray absorptiometry.
J. Durkin (2002)
Can martial arts techniques reduce fall severity? An in vivo study of femoral loading configurations in sideways falls.
A. M. van der Zijden (2012)
Energy absorption during impact on the proximal femur is affected by body mass index and flooring surface.
S. Bhan (2014)
Official Positions for FRAX Clinical Regarding Falls and Frailty: Can Falls and Frailty be Used in FRAX? Journal of Clinical Densitometry
T. Masud (2011)
Predicting the impact response of a nonlinear single-degree-of-freedom shock-absorbing system from the measured step response.
S. Robinovitch (1997)
Hip fracture and anthropometric variations: dominance among trochanteric soft tissue thickness, body height and body weight during sideways fall.
S. Majumder (2013)
Race and sex differences in bone mineral density and geometry at the femur.
M. Peacock (2009)
Femoral neck cortical thickness and intracapsular hip fracture: A re-appraisal
N. Loveridge (2010)
Biomechanical factors affecting the peak hand reaction force during the bimanual arrest of a moving mass.
K. M. DeGoede (2002)
This paper is referenced by
On the internal reaction forces, energy absorption, and fracture in the hip during simulated sideways fall impact
I. Fleps (2018)
Your Walk is My Command: Gait Detection on Unconstrained Smartphone Using IoT System
A. J. Majumder (2016)
Hip Fracture: Anatomy, Causes, and Consequences
Masoud Nasiri Sarvi (2018)
Predicting population level hip fracture risk: a novel hierarchical model incorporating probabilistic approaches and factor of risk principles.
Daniel R Martel (2020)
A multiscale model to predict current absolute risk of femoral fracture in a postmenopausal population
P. Bhattacharya (2019)
Subject-specific ex vivo simulations for hip fracture risk assessment in sideways falls.
I. Fleps (2019)
Participant-Specific Modelling of the Proximal Femur during Lateral Falls: A Mechanistic Evaluation of Risk Factors
Steven P. Pretty (2019)
Modeling Pelvis Contact During Lateral Falls : Multi-Criteria Evaluation of Model Performance and Error Source Identification
I. Levine (2018)
A novel sideways fall simulator to study hip fractures ex vivo
I. Fleps (2018)
Sideways fall-induced impact force and its effect on hip fracture risk: a review
M. Nasiri Sarvi (2017)
Study of sex differences in the association between hip fracture risk and body parameters by DXA-based biomechanical modeling.
M. Nasiri (2016)
Fatal falls in the elderly and the presence of proximal femur fractures
S. Schick (2018)
Improving the prediction of sideways fall-induced impact force for women by developing a female-specific equation.
Masoud Nasiri Sarvi (2019)
Osteoporotic hip fracture prediction: is T-score based criterion enough? A Hip Structural Analysis based model.
A. Aldieri (2018)
The effects of body composition and body configuration on impact dynamics during lateral falls: insights from in-vivo, in-vitro, and in-silico approaches
I. Levine (2017)
Comparison of non-invasive assessments of strength of the proximal femur.
F. Johannesdottir (2017)
Fracture Prediction by Computed Tomography and Finite Element Analysis: Current and Future Perspectives
F. Johannesdottir (2018)
Patient-Specific Bone Multiscale Modelling, Fracture Simulation and Risk Analysis—A Survey
Amadeus C S de Alcântara (2019)
A biomechanical sorting of clinical risk factors affecting osteoporotic hip fracture
Y. Luo (2015)
The influence of muscle activation on impact dynamics during lateral falls on the hip.
Daniel R Martel (2018)
Low-Trauma Accident Fall and Impact Force
Y. Luo (2017)