The effect of boundary and loading conditions on patient classification using finite element predicted risk of fracture
The effect of boundary and loading conditions on patient classification using finite element predicted risk of fracture
BACKGROUND: Osteoporotic proximal femoral fractures associated to falls are a major health burden in the ageing society. Recently, bone strength estimated by finite element models emerged as a feasible alternative to areal bone mineral density as a predictor of fracture risk. However, previous studies showed that the accuracy of patients' classification under their risk of fracture using finite element strength when simulating posterolateral falls is only marginally better than that of areal bone mineral density. Patients tend to fall in various directions: since the predicted strength is sensitive to the fall direction, a prediction based on certain fall directions might not be fully representative of the physical event. Hence, side fall boundary conditions may not be completely representing the physical event.
METHODS: The effect of different side fall boundary and loading conditions on a retrospective cohort of 98 postmenopausal women was evaluated to test models' ability to discriminate fracture and control cases. Three different boundary conditions (Linear, Multi-point constraints and Contact model) were investigated under various anterolateral and posterolateral falls.
FINDINGS: The stratification power estimated by the area under the receiver operating characteristic curve was highest for Contact model (0.82), followed by Multi-point constraints and Linear models with 0.80. Both Contact and MPC models predicted high strains in various locations of the proximal femur including the greater trochanter, which has rarely reported previously.
INTERPRETATION: A full range of fall directions and less restrictive displacement constraints can improve the finite element strength ability to classify patients under their risk of fracture.
Accidental Falls/prevention & control, Aged, Aged, 80 and over, Aging, Bone Density, Case-Control Studies, Cohort Studies, Female, Femur/pathology, Finite Element Analysis, Hip Fractures/diagnosis, Humans, Osteoporotic Fractures/diagnosis, ROC Curve, Retrospective Studies, Risk Assessment, Stress, Mechanical
137-143
Altai, Zainab
9805f920-26fc-47ca-a71c-523fedb7eed7
Qasim, Muhammad
2952cbef-3a52-4fe2-a1a2-c58876c22f91
Li, Xinshan
ea976853-d14c-41a4-ba12-5b700f5858e5
Viceconti, Marco
330883be-abb2-4fd9-9f97-eb4f086be088
1 August 2019
Altai, Zainab
9805f920-26fc-47ca-a71c-523fedb7eed7
Qasim, Muhammad
2952cbef-3a52-4fe2-a1a2-c58876c22f91
Li, Xinshan
ea976853-d14c-41a4-ba12-5b700f5858e5
Viceconti, Marco
330883be-abb2-4fd9-9f97-eb4f086be088
Altai, Zainab, Qasim, Muhammad, Li, Xinshan and Viceconti, Marco
(2019)
The effect of boundary and loading conditions on patient classification using finite element predicted risk of fracture.
Clinical Biomechanics, 68, .
(doi:10.1016/j.clinbiomech.2019.06.004).
Abstract
BACKGROUND: Osteoporotic proximal femoral fractures associated to falls are a major health burden in the ageing society. Recently, bone strength estimated by finite element models emerged as a feasible alternative to areal bone mineral density as a predictor of fracture risk. However, previous studies showed that the accuracy of patients' classification under their risk of fracture using finite element strength when simulating posterolateral falls is only marginally better than that of areal bone mineral density. Patients tend to fall in various directions: since the predicted strength is sensitive to the fall direction, a prediction based on certain fall directions might not be fully representative of the physical event. Hence, side fall boundary conditions may not be completely representing the physical event.
METHODS: The effect of different side fall boundary and loading conditions on a retrospective cohort of 98 postmenopausal women was evaluated to test models' ability to discriminate fracture and control cases. Three different boundary conditions (Linear, Multi-point constraints and Contact model) were investigated under various anterolateral and posterolateral falls.
FINDINGS: The stratification power estimated by the area under the receiver operating characteristic curve was highest for Contact model (0.82), followed by Multi-point constraints and Linear models with 0.80. Both Contact and MPC models predicted high strains in various locations of the proximal femur including the greater trochanter, which has rarely reported previously.
INTERPRETATION: A full range of fall directions and less restrictive displacement constraints can improve the finite element strength ability to classify patients under their risk of fracture.
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More information
Accepted/In Press date: 4 June 2019
e-pub ahead of print date: 6 June 2019
Published date: 1 August 2019
Additional Information:
Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.
Keywords:
Accidental Falls/prevention & control, Aged, Aged, 80 and over, Aging, Bone Density, Case-Control Studies, Cohort Studies, Female, Femur/pathology, Finite Element Analysis, Hip Fractures/diagnosis, Humans, Osteoporotic Fractures/diagnosis, ROC Curve, Retrospective Studies, Risk Assessment, Stress, Mechanical
Identifiers
Local EPrints ID: 447694
URI: http://eprints.soton.ac.uk/id/eprint/447694
ISSN: 0268-0033
PURE UUID: 502afc65-fafc-4f52-8224-e308cac89466
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Date deposited: 18 Mar 2021 17:46
Last modified: 16 Mar 2024 10:48
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Contributors
Author:
Zainab Altai
Author:
Muhammad Qasim
Author:
Xinshan Li
Author:
Marco Viceconti
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