Finite element analysis of the proximal femur and hip fracture risk in older men

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Orwoll, Eric S.¹; Marshall, Lynn M.¹; Nielson, Carrie M.¹; Cummings, Steven R.²; Lapidus, Jodi¹; Cauley, Jane A.³; Ensrud, Kristine⁴; Lane, Nancy⁵; Hoffmann, Paul R.⁶; Kopperdahl, David L.⁶; Keaveny, Tony M.^6,7

Finite element analysis of the proximal femur and hip fracture risk in older men

J Bone Miner Res. March 2009;24(3):475-483

©2009 American Society for Bone and Mineral Research

Affiliations

¹Bone and Mineral Unit, Oregon Health & Science University, Portland Oregon, USA

²Research Institute, California Pacific Medical Center, San Francisco, California, USA

³University of Pittsburgh, Pittsburgh, Pennsylvania, USA

⁴University of Minnesota, Minneapolis, Minnesota, USA

⁵University of California, Davis, Davis, California, USA

⁶O.N. Diagnostics, Berkeley, California, USA

⁷Department of Mechanical Engineering, University of California, Berkeley, Berkeley, California, USA
Abstract and keywords

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.

Keywords: bone strength; fracture risk assessment; osteoporosis; biomechanics
Links

DOI: 10.1359/jbmr.081201

PubMed: 19049327

WoS: 000263572100011
History

Received: 2008-04-16

Revised: 2008-08-12

Accepted: 2008-10-28

Online: 2009-12-01

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