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Finite Element Analysis Of The Proximal Femur And Hip Fracture Risk In Older Men

E. Orwoll, L. Marshall, C. Nielson, S. Cummings, J. Lapidus, J. Cauley, K. Ensrud, N. Lane, P. Hoffmann, D. Kopperdahl, T. M. Keaveny
Published 2009 · Biology, Medicine

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Low areal BMD (aBMD) is associated with increased risk of hip fracture, but many hip fractures occur in persons without low aBMD. Finite element (FE) analysis of QCT scans provides a measure of hip strength. We studied the association of FE measures with risk of hip fracture in older men. A prospective case‐cohort study of all first hip fractures (n = 40) and a random sample (n = 210) of nonfracture cases from 3549 community‐dwelling men ≥65 yr of age used baseline QCT scans of the hip (mean follow‐up, 5.6 yr). Analyses included FE measures of strength and load‐to‐strength ratio and BMD by DXA. Hazard ratios (HRs) for hip fracture were estimated with proportional hazards regression. Both femoral strength (HR per SD change = 13.1; 95% CI: 3.9–43.5) and the load‐to‐strength ratio (HR = 4.0; 95% CI: 2.7–6.0) were strongly associated with hip fracture risk, as was aBMD as measured by DXA (HR = 5.1; 95% CI: 2.8–9.2). After adjusting for age, BMI, and study site, the associations remained significant (femoral strength HR = 6.5, 95% CI: 2.3–18.3; load‐to‐strength ratio HR = 4.3, 95% CI: 2.5–7.4; aBMD HR = 4.4, 95% CI: 2.1–9.1). When adjusted additionally for aBMD, the load‐to‐strength ratio remained significantly associated with fracture (HR = 3.1, 95% CI: 1.6–6.1). These results provide insight into hip fracture etiology and demonstrate the ability of FE‐based biomechanical analysis of QCT scans to prospectively predict hip fractures in men.
This paper references
Hayes WC 1994 severity and bone mineral density as risk factor for hip fracture in ambulatory elderly
S L Greenspan
10.1016/J.BONE.2003.10.001
Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study.
S. C. Schuit (2004)
10.1097/01.OGX.0000137847.76999.D4
Bone mineral density thresholds for pharmacological intervention to prevent fractures.
E. Siris (2004)
10.1016/J.BONE.2005.11.020
Young-elderly differences in bone density, geometry and strength indices depend on proximal femur sub-region: a cross sectional study in Caucasian-American women.
M. Meta (2006)
10.1359/JBMR.050609
Identification of Osteopenic Women at High Risk of Fracture: The OFELY Study
E. Sornay-Rendu (2005)
Prediction of femoral fracture load and location using CT scan-derived finite element models
JH Keyak (1995)
10.1016/S0021-9290(03)00257-4
Comparison of the elastic and yield properties of human femoral trabecular and cortical bone tissue.
Harun H. Bayraktar (2004)
10.1148/RADIOLOGY.179.3.2027972
Effect of bone distribution on vertebral strength: assessment with patient-specific nonlinear finite element analysis.
K. Faulkner (1991)
Exploring the shape of univariate data using kernel density estimators
I. H. Salgado-Ugarte (1994)
10.1359/jbmr.040916
Population‐Based Study of Age and Sex Differences in Bone Volumetric Density, Size, Geometry, and Structure at Different Skeletal Sites
B. Riggs (2004)
10.1017/cbo9780511815553.010
Strength
S. Beer (2002)
10.1016/J.CCT.2005.05.006
Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study--a large observational study of the determinants of fracture in older men.
E. Orwoll (2005)
10.1016/S8756-3282(96)00383-3
Assessment of the strength of proximal femur in vitro: relationship to femoral bone mineral density and femoral geometry.
X. Cheng (1997)
10.1359/jbmr.060506
Dimensions and Volumetric BMD of the Proximal Femur and Their Relation to Age Among Older U.S. Men
L. Marshall (2006)
10.1016/J.BONE.2006.06.018
Proximal femoral density and geometry measurements by quantitative computed tomography: association with hip fracture.
X. Cheng (2007)
10.1016/S1350-4533(01)00045-5
Improved prediction of proximal femoral fracture load using nonlinear finite element models.
J. Keyak (2001)
10.1016/S8756-3282(97)00072-0
Volumetric quantitative computed tomography of the proximal femur: precision and relation to bone strength.
T. Lang (1997)
10.1097/01.blo.0000174736.50964.3b
Predicting the Strength of Femoral Shafts with and without Metastatic Lesions
J. Keyak (2005)
Resnick NM 1998 direction, bone mineral density, and function: Risk factors for hip fracture in frail nursing home elderly
S L Greenspan
Fracture incidence and association with
SC Schuit (2004)
10.1016/S1350-4533(98)00054-X
Comparison of geometry-based and CT voxel-based finite element modelling and experimental validation.
M. Lengsfeld (1998)
10.1115/1.2794186
Dynamic models for sideways falls from standing height.
A. J. van den Kroonenberg (1995)
10.1359/jbmr.2001.16.12.2276
The Biomechanical Basis of Vertebral Body Fragility in Men and Women
Y. Duan (2001)
10.1359/jbmr.080316
Proximal Femoral Structure and the Prediction of Hip Fracture in Men: A Large Prospective Study Using QCT
D. Black (2008)
10.1359/jbmr.070309
Contribution of Trochanteric Soft Tissues to Fall Force Estimates, the Factor of Risk, and Prediction of Hip Fracture Risk*
M. Bouxsein (2007)
10.1007/s002239900727
Factor of Risk for Hip Fracture in Normal Chinese Men and Women in Taiwan
R. S. Yang (1999)
10.1016/J.JBIOMECH.2007.05.008
Side-artifact errors in yield strength and elastic modulus for human trabecular bone and their dependence on bone volume fraction and anatomic site.
G. Bevill (2007)
10.1097/00002517-199407020-00002
Three-dimensional finite element modeling of a cervical vertebra: an investigation of burst fracture mechanism.
K. Bozic (1994)
10.1016/S0021-9290(99)00202-X
Relationships between femoral fracture loads for two load configurations.
J. Keyak (2000)
10.1016/0141-5425(90)90022-F
Automated three-dimensional finite element modelling of bone: a new method.
J. Keyak (1990)
10.1016/S0021-9290(03)00071-X
Trabecular bone modulus-density relationships depend on anatomic site.
E. Morgan (2003)
Cummings SR for the Osteoporotic Fractures Research Group 2003 BMD at multiple sites and risk of fracture of multiple types: Long-term results from the Study of Osteoporotic Fractures
K L Stone
10.1007/BF02500246
Noninvasive assessment of stiffness and failure load of humane vertebrae from CT data
H. Martin (2006)
Biomechanics of fracture risk prediction of the hip and spine by quantitative computed tomography.
W. Hayes (1991)
10.1097/00007632-199712151-00005
Biomechanics of osteoporosis and vertebral fracture.
E. Myers (1997)
10.1016/S0895-4356(99)00102-X
Analysis of case-cohort designs.
W. Barlow (1999)
10.1002/JOR.1100130621
Force attenuation in trochanteric soft tissues during impact from a fall
S. Robinovitch (1995)
10.1016/S0021-9290(97)00123-1
Prediction of femoral fracture load using automated finite element modeling.
J. Keyak (1998)
10.1016/J.BONE.2006.10.025
Comparison of quantitative computed tomography-based measures in predicting vertebral compressive strength.
J. Buckley (2007)
10.1016/J.CCT.2005.05.005
Overview of recruitment for the osteoporotic fractures in men study (MrOS).
Janet Babich Blank (2005)
10.1016/0021-9290(75)90075-5
The elastic and ultimate properties of compact bone tissue.
D. Reilly (1975)
10.1016/S0002-9343(98)00115-6
Fall direction, bone mineral density, and function: risk factors for hip fracture in frail nursing home elderly.
S. Greenspan (1998)
10.1097/00007632-200107150-00010
Osteoporosis Changes the Amount of Vertebral Trabecular Bone at Risk of Fracture but Not the Vertebral Load Distribution
J. Homminga (2001)
10.1097/01.brs.0000182097.91219.78
Estimated Risk Score for Spine Fracture in the Specific Bending Activity of Normal Taiwanese Men and Women
R. Yang (2005)
10.1359/JBMR.050304
Predictive Value of BMD for Hip and Other Fractures
O. Johnell (2005)
Nonlinear finite element model predicts vertebral bone strength and fracture site. Spine 31:1789–1794
K Imai (2006)
10.1001/JAMA.1994.03510260060029
Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly.
S. Greenspan (1994)
10.2106/00004623-199503000-00008
Age-related reductions in the strength of the femur tested in a fall-loading configuration.
A. Courtney (1995)
10.1146/ANNUREV.BIOENG.3.1.307
Biomechanics of trabecular bone.
T. M. Keaveny (2001)
10.1111/1541-0420.00016
Selecting differentially expressed genes from microarray experiments.
M. Pepe (2003)
10.1007/BF00310169
Effects of loading rate on strength of the proximal femur
A. Courtney (2004)
10.1007/s00198-005-1893-5
The fracture risk index and bone mineral density as predictors of vertebral structural failure
Y. Duan (2005)
10.1007/s00198-006-0074-5
Volumetric quantitative computed tomography of the proximal femur: relationships linking geometric and densitometric variables to bone strength. Role for compact bone
V. Bousson (2006)
10.1016/S0021-9290(99)00099-8
Femoral strength is better predicted by finite element models than QCT and DXA.
D. Cody (1999)
10.1359/jbmr.060606
Age‐ and Sex‐Specific Differences in the Factor of Risk for Vertebral Fracture: A Population‐Based Study Using QCT
M. Bouxsein (2006)
10.1359/jbmr.2003.18.11.1947
BMD at Multiple Sites and Risk of Fracture of Multiple Types: Long‐Term Results From the Study of Osteoporotic Fractures
K. Stone (2003)
10.1210/JC.2004-1568
Hip fracture in women without osteoporosis.
Stacey A Wainwright (2005)
mineral density and femoral geometry
O Johnell (2005)
10.1097/01.brs.0000225993.57349.df
Nonlinear Finite Element Model Predicts Vertebral Bone Strength and Fracture Site
K. Imai (2006)
10.1016/S1350-4533(01)00094-7
Prediction of fracture location in the proximal femur using finite element models.
J. Keyak (2001)
10.1016/S8756-3282(03)00210-2
Finite element models predict in vitro vertebral body compressive strength better than quantitative computed tomography.
R. Crawford (2003)
10.1111/1541-0420.00071
Partial AUC estimation and regression.
L. Dodd (2003)
10.1016/J.JBIOMECH.2006.05.012
The effects of side-artifacts on the elastic modulus of trabecular bone.
Kerem Un (2006)
10.1359/jbmr.070728
Structural Determinants of Vertebral Fracture Risk
L. J. Melton (2007)
10.1016/S0021-9290(97)00073-0
An improved method for finite element mesh generation of geometrically complex structures with application to the skullbase.
D. Camacho (1997)
10.1016/B978-012470862-4/50020-9
Biomechanics of Age-Related Fractures
M. L. Bouxsein (2001)
10.1359/JBMR.051022
Population‐Based Analysis of the Relationship of Whole Bone Strength Indices and Fall‐Related Loads to Age‐ and Sex‐Specific Patterns of Hip and Wrist Fractures
B. Riggs (2006)
10.1007/BF02508641
Impact direction from a fall influences the failure load of the proximal femur as much as age-related bone loss
T. Pinilla (2006)
fracture in the specific bending activity of normal Taiwanese men and women
BL Riggs (2006)
Young - elderly differences in
M Meta (2006)
Partial AUC estimation and regression. Biometrics 59:614–623
LE Dodd (2003)
SR for the Osteoporotic Fractures Research Group 2003 BMD at multiple sites and risk of fracture of multiple types: Long-term results from the Study of Osteoporotic Fractures
KL Stone (1954)
10.1016/S0021-9290(01)00011-2
Dependence of yield strain of human trabecular bone on anatomic site.
E. Morgan (2001)



This paper is referenced by
Award Number: W81XWH-10-1-0951 TITLE: Effect of Teriparatide, Vibration and the Combination on Bone Mass and Bone Architecture in Chronic Spinal Cord Injury
P. Investigator (2012)
Human Research Program Human Health and Countermeasures Element
Harlan J. Evans (2017)
10.1371/journal.pone.0229820
Artificial neural network analysis of bone quality DXA parameters response to teriparatide in fractured osteoporotic patients
C. Messina (2020)
10.2147/IJWH.S112621
Bone strength and management of postmenopausal fracture risk with antiresorptive therapies: considerations for women’s health practice
A. Cheung (2016)
10.1016/j.medengphy.2017.11.002
Validation of an alignment method using motion tracking system for in-vitro orientation of cadaveric hip joints with reduced set of anatomical landmarks.
S. Bsat (2018)
10.1007/s10439-010-0196-y
Robust QCT/FEA Models of Proximal Femur Stiffness and Fracture Load During a Sideways Fall on the Hip
D. Dragomir-Daescu (2010)
10.1007/s11914-012-0101-8
The Contribution of the Extracellular Matrix to the Fracture Resistance of Bone
J. Nyman (2012)
10.1016/j.jbiomech.2014.08.024
To what extent can linear finite element models of human femora predict failure under stance and fall loading configurations?
E. Schileo (2014)
Testosterone and Vitamin D Deficiency as Risk Factors for Hip Fracture Elderly Male Patients: Time for Vitamin D and Testosterone Replacement
Magbri (2016)
How to Best Predict Fragility Fractures: An Update and Systematic Review.
R. Allon (2018)
10.2217/IJR.10.16
Bone densitometry and true BMD accuracy for predicting fractures: what are the alternatives?
H. Sievänen (2010)
10.1007/S12018-009-9066-2
Clinical Tools to Evaluate Bone Strength
S. Manske (2010)
10.1007/8415_2011_110
Factor of Risk for Fracture
Dennis Earl Anderson (2013)
10.1016/j.clinbiomech.2013.12.018
How accurately can we predict the fracture load of the proximal femur using finite element models?
Sven van den Munckhof (2014)
10.1210/jc.2015-1860
Evaluation of Bone Mineral Density and Bone Biomarkers in Patients With Type 2 Diabetes Treated With Canagliflozin.
J. Bilezikian (2016)
10.18203/2349-3259.IJCT20161408
In silico clinical trials: how computer simulation will transform the biomedical industry
M. Viceconti (2016)
10.1016/j.bone.2017.07.029
Phantomless calibration of CT scans for measurement of BMD and bone strength-Inter-operator reanalysis precision.
David C. Lee (2017)
10.1007/s00198-018-4716-1
Prediction of incident vertebral fracture using CT-based finite element analysis
B. Allaire (2018)
10.1002/jbmr.2359
Rates of and Risk Factors for Trabecular and Cortical BMD Loss in Middle‐Aged and Elderly African‐Ancestry Men
Y. Sheu (2015)
10.1210/jc.2016-3177
Cortical Bone Area Predicts Incident Fractures Independently of Areal Bone Mineral Density in Older Men
C. Ohlsson (2017)
10.1007/s12018-015-9196-7
Clinical Aspects of Fracture Healing: An Overview
James Liu (2015)
Risk of Bone Fracture due to Spaceflight-induced Changes to Bone Human Research Program Exploration Medical Capabilities Element
H. Evans (2017)
10.1007/s11657-018-0507-8
Progressive bone impairment with age and pubertal development in neurofibromatosis type I
G. Rodari (2018)
10.1002/jbmr.2474
Reduction in Torsional Stiffness and Strength at the Proximal Tibia as a Function of Time Since Spinal Cord Injury
W. B. Edwards (2015)
10.1080/10255842.2016.1181173
Interactive graph-cut segmentation for fast creation of finite element models from clinical ct data for hip fracture prediction
Y. Pauchard (2016)
10.1016/j.jocd.2013.03.005
Fracture risk assessment in older adults using a combination of selected quantitative computed tomography bone measures: a subanalysis of the Age, Gene/Environment Susceptibility-Reykjavik Study.
N. Rianon (2014)
10.1115/1.4025776
Development of a hip joint model for finite volume simulations.
Philip Cardiff (2014)
comprehensive assessment of Osteoporosis and Bone Fragility
Jeff L. Fidler (2016)
10.1007/s11914-015-0288-6
Bone Imaging and Fracture Risk after Spinal Cord Injury
W. B. Edwards (2015)
Prediction of The Strength of Human Long Bone Using CT Based Finite Element Method
Z. Altai (2018)
10.36959/832/387
The Prevalence of Vitamin D Deficiency and Secondary Hyperparathyroidism in Elderly Male Patients with Hip Fracture: Time for Vitamin D and Testosterone Replacement
Magbri Awad (2016)
10.1002/jbmr.2241
Fracture Risk Predictions Based on Statistical Shape and Density Modeling of the Proximal Femur
T. Bredbenner (2014)
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