Prediction of new clinical vertebral fractures in elderly men using finite element analysis of CT scans

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Wang, Xiang¹; Sanyal, Arnav¹; Cawthon, Peggy M.²; Palermo, Lisa³; Jekir, Michael¹; Christensen, John¹; Ensrud, Kristine E.⁴; Cummings, Steven R.²; Orwoll, Eric⁵; Black, Dennis M.³; Keaveny, Tony M.^1,6

Prediction of new clinical vertebral fractures in elderly men using finite element analysis of CT scans

J Bone Miner Res. April 2012;27(4):808-816

©2020 American Society for Bone and Mineral Research

Affiliations

¹Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, USA

²San Francisco Coordinating Center, California Pacific Medical Center, San Francisco, CA, USA

³Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

⁴Veteran's Affairs Medical Center and University of Minnesota, Minneapolis, MN, USA

⁵Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA

⁶Department of Bioengineering, University of California, Berkeley, Berkeley, CA, USA
Abstract and keywords

Vertebral strength, as estimated by finite element analysis of computed tomography (CT) scans, has not yet been compared against areal bone mineral density (BMD) by dual‐energy X‐ray absorptiometry (DXA) for prospectively assessing the risk of new clinical vertebral fractures. To do so, we conducted a case‐cohort analysis of 306 men aged 65 years and older, which included 63 men who developed new clinically‐identified vertebral fractures and 243 men who did not, all observed over an average of 6.5 years. Nonlinear finite element analysis was performed on the baseline CT scans, blinded to fracture status, to estimate L1 vertebral compressive strength and a load‐to‐strength ratio. Volumetric BMD by quantitative CT and areal BMD by DXA were also evaluated. We found that, for the risk of new clinical vertebral fracture, the age‐adjusted hazard ratio per standard deviation change for areal BMD (3.2; 95% confidence interval [CI], 2.0–5.2) was significantly lower (p p = 0.02), volumetric BMD (AUC = 0.82, p = 0.05), and the load‐to‐strength ratio (AUC = 0.82, p = 0.05). We conclude that, compared to areal BMD by DXA, vertebral compressive strength and volumetric BMD consistently improved vertebral fracture risk assessment in this cohort of elderly men.

Keywords: OSTEOPOROSIS; SPINE FRACTURE; BONE STRENGTH; FINITE ELEMENT ANALYSIS; BIOMECHANICS
Links

DOI: 10.1002/jbmr.1539

PubMed: 22190331

WoS: 000301708100010
History

Received: 2011-10-6

Revised: 2011-11-8

Accepted: 2011-12-16

Online: 2012-03-20

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