Prediction of osteoporotic fragility re-fracture with lumbar spine DXA-based derived bone strain index:​ a multicenter validation study

Messina, C.; Rinaudo, L.; Cesana, B. M.; Maresca, D.; Piodi, L. P.; Sconfienza, L. M.; Sardanelli, F.; Ulivieri, F. M.

Affiliations

¹Unità di Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy

²Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100 Milano, Italy

³TECHNOLOGIC Srl, Lungo Dora Voghera 34/36, 10153 Torino, Italy

⁴Unità di Statistica Medica, Biometria e Bioinformatica “Giulio A. Maccacaro”, Dipartimento di Scienze Cliniche e Salute della Comunità, Università degli Studi di Milano, Via Vanzetti 5, 20100 Milano, Italy

⁵Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy

⁶Milano, Italy

⁷Unità di Radiologia, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, MI, Italy

⁸Unità di Medicina Nucleare, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy

⁹Present address: Centro per la Diagnosi e la Terapia dell’Osteoporosi. Casa di Cura La Madonnina, Via Quadronno 29, 20122 Milano, Italy

Abstract and keywords

Summary: A new qualitative index of bone strength, based on finite element analysis and named bone strain index, has been recently developed from lumbar DXA scan. This study shows that BSI predicts subsequent re-fracture in osteoporotic patients affected by fragility fractures.

Introduction: Dual-energy X-ray absorptiometry (DXA) can provide quantitative (bone mineral density, BMD) and qualitative (trabecular bone score, TBS) indexes of bone status, able to predict fragility fractures in most osteoporotic patients. A new qualitative index of bone strength, based on finite element analysis and named bone strain index (BSI), has been recently developed from lumbar DXA scan. This study presents the validation results of BSI prediction for re-fracture in osteoporotic patients with fragility fractures.

Methods: In three academic hospitals, 234 consecutive fractured patients with primary osteoporosis (209 females) performed a spine X-ray for the calculation of spine deformity index (SDI) and DXA densitometry for BMD, TBS and BSI at the basal time and in the follow-up at each clinical check. A subsequent fracture was considered as one unity increase of SDI.

Results: For each unit increase of the investigated indexes, the univariate hazard ratio of re-fracture, 95% CI, p value and proportionality test p value are for age 1.040, 1.017–1.064, 0.0007 and 0.2529, respectively, and for BSI 1.372, 1.038–1.813, 0.0261 and 0.5179, respectively. BSI remained in the final multivariate model as a statistically significant independent predictor of a subsequent re-fracture (1.332, 1.013–1.752 and 0.0399) together with age (1.039, 1.016–1.064 and 0.0009); for this multivariate model proportionality test, p value is 0.4604.

Conclusions: BSI appears to be a valid DXA index of prediction of re-fracture, and it can be used for a more refined risk assessment of osteoporotic patients.

Keywords: Bone mineral density; Bone strain index; DXA; Fracture prediction; Trabecular bone score

Links

DOI: 10.1007/s00198-020-05620-9

PubMed: 32936366

WoS: 000570037000001

History

Received: 2020-05-19

Accepted: 2020-09-01

Online: 2020-09-16

Cited Works (13)

Year	Entry
1993	Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. June 1993;94(6):646-650.
2001	Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E. Risk of new vertebral fracture in the year following a fracture. JAMA. January 17, 2001;285(6):320-323.
2004	Siris ES, Chen Y-T, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, Berger ML. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. May 24, 2004;164(10):1108-1112.
2015	Silva BC, Broy SB, Boutroy S, Schousboe JT, Shepherd JA, Leslie WD. Fracture risk prediction by non-BMD DXA measures: the 2015 ISCD official positions part 2: trabecular bone score. J Clin Densitom. July–September 2015;18(3):309-330.
2019	Kanis JA, Cooper C, Rizzoli R, Reginster J-Y; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO); Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. January 2019;30(1):3-44.
2006	Seeman E, Delmas PD. Bone quality: the material and structural basis of bone strength and fragility. NEJM. May 25, 2006;354(21):2250-2261.
2011	Cole JH, van der Meulen MCH. Whole bone mechanics and bone quality. Clin Orthop Relat Res. August 2011;469(8):2139-2149.
1993	Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. September 1993;8(9):1137-1148.
2009	Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C; FREEDOM Trial. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. NEJM. August 20, 2009;361(8):756-765.
2011	Hans D, Barthe N, Boutroy S, Pothuaud L, Winzenrieth R, Krieg M-A. Correlations between trabecular bone score, measured using anteroposterior dual-energy x-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: an experimental study on human cadaver vertebrae. J Clin Densitom. July 1, 2011;14(3):302-312.
2019	Colombo C, Libonati F, Rinaudo L, Bellazzi M, Ulivieri FM, Vergani L. A new finite element based parameter to predict bone fracture. PLoS One. December 5, 2019;14(12):e0225905.
2011	Hans D, Goertzen AL, Krieg M-A, Leslie WD. Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J Bone Miner Res. November 2011;26(11):2762-2769.
1996	Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. May 18, 1996;312(7041):1254-1259.

Cited By (2)

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.
2021	Ulivieri FM, Rinaudo L. Beyond bone mineral density: a new dual x-ray absorptiometry index of bone strength to predict fragility fractures, the bone strain index. Front Med. January 15, 2021;7:590139.