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Patient-specific finite element estimated femur strength as a predictor of the risk of hip fracture: the effect of methodological determinants

Patient-specific finite element estimated femur strength as a predictor of the risk of hip fracture: the effect of methodological determinants
Patient-specific finite element estimated femur strength as a predictor of the risk of hip fracture: the effect of methodological determinants
Summary A finite element modelling pipeline was adopted to predict femur strength in a retrospective cohort of 100 women. The effects of the imaging protocol and the meshing technique on the ability of the femur strength to classify the fracture and the control groups were analysed.Introduction The clinical standard to estimate the risk of osteoporotic hip fracture is based on the areal bone mineral density (aBMD). A few retrospective studies have concluded that finite element (FE)-based femoral strength is a better classifier of fracture and control groups than the aBMD, while others could not find significant differences. We investigated the effect of the imaging protocol and of the FE modelling techniques on the discriminatory power of femoral strength.
Methods A retrospective cohort of 100 post-menopausal women (50 with hip fracture, 50 controls) was examined. Each subject received a dual-energy absorptiometry (DXA) exam and a computed tomography (CT) scan of the proximal femur region. Each case was modelled a number of times, using different modelling pipelines, and the results were compared in terms of accuracy in discriminating the fracture and the control cases. The baseline pipeline involved local anatomical orientation and mesh morphing. Revised pipelines involved global anatomical orientation using a full-femur atlas registration and an optimised meshing algorithm. Minimum physiological (MPhyS) and pathological (MPatS) strengths were estimated for each subject. Area under the receiver operating characteristic (ROC) curve (AUC) was calculated to compare the ability of MPhyS, MPatS and aBMD to classify the control and the cases.
Results Differences in the modelling protocol were found to considerably affect the accuracy of the FE predictors. For the most optimised protocol, logistic regression showed aBMDNeck, MPhyS and MPatS to be significantly associated with the facture status, with AUC of 0.75, 0.75 and 0.79, respectively.
Conclusion The study emphasized the necessity of modelling the whole femur anatomy to develop a robust FE-based tool for hip fracture risk assessment. FE-strength performed only slightly better than the aBMD in discriminating the fracture and control cases. Differences between the published studies can be explained in terms of differences in the modelling protocol and cohort design.
Absorptiometry, Photon, Aged, Aged, 80 and over, Bone Density, Female, Femur/pathology, Finite Element Analysis, Hip Fractures/diagnosis, Humans, Osteoporotic Fractures/diagnosis, Postmenopause, Retrospective Studies, Tomography, X-Ray Computed
0937-941X
2815-2822
Qasim, M.
2952cbef-3a52-4fe2-a1a2-c58876c22f91
Farinella, G.
eaaf98a4-d68a-4d8b-8968-54aaac7651f0
Zhang, J.
4cb1ed20-f74c-4b0c-a3aa-29761b0640b7
Li, X.
0c1123c2-1648-40ba-a5a0-7a39540c1251
Yang, L.
9410f7c5-c502-4c45-8a94-e865854b5579
Eastell, R.
1650872d-d27d-4543-a112-d6008810fa25
Viceconti, M.
dfd704ca-a3c5-4761-8b13-aee95ea66e0a
Qasim, M.
2952cbef-3a52-4fe2-a1a2-c58876c22f91
Farinella, G.
eaaf98a4-d68a-4d8b-8968-54aaac7651f0
Zhang, J.
4cb1ed20-f74c-4b0c-a3aa-29761b0640b7
Li, X.
0c1123c2-1648-40ba-a5a0-7a39540c1251
Yang, L.
9410f7c5-c502-4c45-8a94-e865854b5579
Eastell, R.
1650872d-d27d-4543-a112-d6008810fa25
Viceconti, M.
dfd704ca-a3c5-4761-8b13-aee95ea66e0a

Qasim, M., Farinella, G., Zhang, J., Li, X., Yang, L., Eastell, R. and Viceconti, M. (2016) Patient-specific finite element estimated femur strength as a predictor of the risk of hip fracture: the effect of methodological determinants. Osteoporosis International, 27 (9), 2815-2822. (doi:10.1007/s00198-016-3597-4).

Record type: Article

Abstract

Summary A finite element modelling pipeline was adopted to predict femur strength in a retrospective cohort of 100 women. The effects of the imaging protocol and the meshing technique on the ability of the femur strength to classify the fracture and the control groups were analysed.Introduction The clinical standard to estimate the risk of osteoporotic hip fracture is based on the areal bone mineral density (aBMD). A few retrospective studies have concluded that finite element (FE)-based femoral strength is a better classifier of fracture and control groups than the aBMD, while others could not find significant differences. We investigated the effect of the imaging protocol and of the FE modelling techniques on the discriminatory power of femoral strength.
Methods A retrospective cohort of 100 post-menopausal women (50 with hip fracture, 50 controls) was examined. Each subject received a dual-energy absorptiometry (DXA) exam and a computed tomography (CT) scan of the proximal femur region. Each case was modelled a number of times, using different modelling pipelines, and the results were compared in terms of accuracy in discriminating the fracture and the control cases. The baseline pipeline involved local anatomical orientation and mesh morphing. Revised pipelines involved global anatomical orientation using a full-femur atlas registration and an optimised meshing algorithm. Minimum physiological (MPhyS) and pathological (MPatS) strengths were estimated for each subject. Area under the receiver operating characteristic (ROC) curve (AUC) was calculated to compare the ability of MPhyS, MPatS and aBMD to classify the control and the cases.
Results Differences in the modelling protocol were found to considerably affect the accuracy of the FE predictors. For the most optimised protocol, logistic regression showed aBMDNeck, MPhyS and MPatS to be significantly associated with the facture status, with AUC of 0.75, 0.75 and 0.79, respectively.
Conclusion The study emphasized the necessity of modelling the whole femur anatomy to develop a robust FE-based tool for hip fracture risk assessment. FE-strength performed only slightly better than the aBMD in discriminating the fracture and control cases. Differences between the published studies can be explained in terms of differences in the modelling protocol and cohort design.

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More information

e-pub ahead of print date: 23 April 2016
Published date: 1 September 2016
Keywords: Absorptiometry, Photon, Aged, Aged, 80 and over, Bone Density, Female, Femur/pathology, Finite Element Analysis, Hip Fractures/diagnosis, Humans, Osteoporotic Fractures/diagnosis, Postmenopause, Retrospective Studies, Tomography, X-Ray Computed

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Local EPrints ID: 446775
URI: http://eprints.soton.ac.uk/id/eprint/446775
ISSN: 0937-941X
PURE UUID: b660ef07-76ec-4d00-98ed-331ab09ae02a

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Date deposited: 22 Feb 2021 17:31
Last modified: 26 Apr 2022 18:25

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Contributors

Author: M. Qasim
Author: G. Farinella
Author: J. Zhang
Author: X. Li
Author: L. Yang
Author: R. Eastell
Author: M. Viceconti

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