Peripheral quantitative computed tomography (pQCT)–based finite element analysis provides enhanced diagnostic performance in identifying non-vertebral fracture patients compared with dual-energy X-ray absorptiometry

Jiang, H.<sup>1</sup>; Robinson, D. L.<sup>2</sup>; Yates, C. J.<sup>1,3,4</sup>; Lee, P. V. S.<sup>2</sup>; Wark, J. D.<sup>1,3,4</sup>

Affiliations

¹Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia

²Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia

³Bone and Mineral Medicine, Royal Melbourne Hospital, Melbourne, Australia

⁴Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia

Abstract and keywords

Summary: Due to limitations of the predominant clinical method for diagnosing osteoporosis, an engineering model based on a dedicated CT scanner for bone density and structure was applied in fracture patients and controls. Improved diagnostic performance was observed, which supports its potential use in future research and clinical practice.

Introduction: Dual-energy X-ray absorptiometry (DXA), the predominant clinical method for diagnosing osteoporosis, has limitations in identifying individuals with increased fracture risk. Peripheral quantitative computed tomography (pQCT) provides additional information and can be used to generate finite element (FE) models from which bone strength properties can be estimated. We investigated the ability of pQCT-FE properties to distinguish peripheral low-trauma fracture patients from healthy controls, by comparison with DXA and standard pQCT.

Methods: One hundred and eight fracture patients (77 females aged 67.7 ± 7.9 years, 31 males aged 69.7 ± 8.9 years) were recruited from a hospital fracture liaison service. One hundred and twenty healthy community controls (85 females aged 69.8 ± 8.5 years, 35 males aged 68.9 ± 7.2 years) were recruited.

Results: Significant differences between groups were observed in pQCT-FE properties, especially at the 4% tibia site. Fracture odds increased most per standard deviation decrease in pQCT-FE at this location [shear stiffness estimate, k_shear, in females, OR = 10.34, 95% CI (1.91, 43.98); bending stiffness estimate, kbend, in males, OR = 8.32, 95% CI (4.15, 33.84)]. Area under the receiver operating characteristics curve (AUROC) was observed to be highest with pQCT-FE properties at 4% the tibia site. In females, this was 0.83 for the pQCT-FE variable k_shear, compared with 0.72 for DXA total hip bone density (TH aBMD) and 0.76 for pQCT tibia trabecular density (Trb vBMD); in males, this was 0.81 for the pQCT-FE variable kbend at the 4% tibia site, compared with 0.62 for TH aBMD and 0.71 for Trb vBMD. There were significant differences in AUROC between DXA and pQCT-FE variables in both females (p = 0.02) and males (p = 0.03), while no difference was observed in AUROC between primary pQCT and pQCT-FE variables.

Conclusions: pQCT-FE modeling can provide enhanced diagnostic performance compared with DXA and, given its moderate cost, may be useful in clinical settings.

Keywords: AUROC; bone strength; fracture status; finite element modeling; pQCT

Links

DOI: 10.1007/s00198-019-05213-1

PubMed: 31720708

WoS: 000496218000008

History

Received: 2019-05-05

Accepted: 2019-10-28

Online: 2019-11-13

Cited Works (20)

Year	Entry
2003	Muller ME, Webber CE, Bouxsein ML. Predicting the failure load of the distal radius. Osteoporos Int. June 2003;14(4):345-352.
2008	Boyd SK. Site-specific variation of bone micro-architecture in the distal radius and tibia. J Clin Densitom. July–September 2008;11(3):424-430.
2008	Boutroy S, Van Rietbergen B, Sornay-Rendu E, Munoz F, Bouxsein ML, Delmas PD. Finite element analysis based on in vivo HR-pQCT images of the distal radius is associated with wrist fracture in postmenopausal women. J Bone Miner Res. March 2008;23(3):392-399.
2011	Sheu Y, Zmuda JM, Boudreau RM, Petit MA, Ensrud KE, Bauer DC, Gordon CL, Orwoll ES, Cauley JA; Osteoporotic Fractures in Men (MrOS) Research Group. Bone strength measured by peripheral quantitative computed tomography and the risk of nonvertebral fractures: the osteoporotic fractures in men (MrOS) study. J Bone Miner Res. January 2011;26(1):63-71.
1988	DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. September 1988;44(3):837-845.
2008	Clarke B. Normal bone anatomy and physiology. Clin J Am Soc Nephrol. November 2008;3(suppl 3):S131-S139.
2017	Sornay‐Rendu E, Boutroy S, Duboeuf F, Chapurlat RD. Bone microarchitecture assessed by HR‐pQCT as predictor of fracture risk in postmenopausal women: the OFELY study. J Bone Miner Res. June 2017;32(6):1243-1251.
2003	Stone KL, Seeley DG, Lui L-Y, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR; The Study of Osteoporotic Fractures research group. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res. November 2003;18(11):1947-1954.
2013	Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos. December 2013;8(1):136.
1999	Ulrich D, van Rietbergen B, Laib A, Rüegsegger P. Load transfer analysis of the distal radius from in-vivo high-resolution CT-imaging. J Biomech. August 1999;32(8):821-828.
2013	Nishiyama KK, Macdonald HM, Hanley DA, Boyd SK. Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT. Osteoporos Int. May 2013;24(5):1733-1740.
2014	Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson‐Hughes B. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. November 2014;29(11):2520-2526.
2011	Vilayphiou N, Boutroy S, Szulc P, van Rietbergen B, Munoz F, Delmas PD, Chapurlat R. Finite element analysis performed on radius and tibia HR‐pQCT images and fragility fractures at all sites in men. J Bone Miner Res. May 2011;26(5):965-973.
2013	Nishiyama KK, Gilchrist S, Guy P, Cripton P, Boyd SK. Proximal femur bone strength estimated by a computationally fast finite element analysis in a sideways fall configuration. J Biomech. April 26, 2013;46(7):1231-1236.
2008	Gray HA, Taddei F, Zavatsky AB, Cristofolini L, Gill HS. Experimental validation of a finite element model of a human cadaveric tibia. J Biomech Eng. June 2008;130(3):031016.
2001	van Staa TP, Dennison EM, Leufkens HGM, Cooper C. Epidemiology of fractures in England and Wales. Bone. January 2001;29(6):517-522.
2007	Sornay‐Rendu E, Boutroy S, Munoz F, Delmas PD. Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, partially independent of decreased BMD measured by DXA: the OFELY study. J Bone Miner Res. March 2007;22(3):425-433.
1999	Cody DD, Gross GJ, Hou FJ, Spencer HJ, Goldstein SA, Fyhrie DP. Femoral strength is better predicted by finite element models than QCT and DXA. J Biomech. October 1999;32(10):1013-1020.
2012	Edwards WB, Troy KL. Finite element prediction of surface strain and fracture strength at the distal radius. Med Eng Phys. April 2012;34(3):290-298.
2003	Morgan EF, Bayraktar HH, Keaveny TM. Trabecular bone modulus–density relationships depend on anatomic site. J Biomech. July 2003;36(7):897-904.

Cited By (3)

Year	Entry
2022	Sornay-Rendu E, Duboeuf F, Ulivieri FM, Rinaudo L, Chapurlat R. The bone strain index predicts fragility fractures: the OFELY study. Bone. April 2022;157:116348.
2023	Dao T, Robinson DL, Doyle LW, Lee PVS, Olsen J, Kale A, Cheong JLY, Wark JD. Quantifying bone strength deficits in young adults born extremely preterm or extremely low birth weight. J Bone Miner Res. December 2023;38(12):1800-1808.
2021	Jiang H, Robinson DL, Lee PVS, Krejany EO, Yates CJ, Hickey M, Wark JD. Loss of bone density and bone strength following premenopausal risk–reducing bilateral salpingo-oophorectomy: a prospective controlled study (WHAM Study). Osteoporos Int. January 2021;32(1):101-112.