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Quantitating age-related BMD textural variation from DXA region-free-analysis: a study of hip fracture prediction in three cohorts

Quantitating age-related BMD textural variation from DXA region-free-analysis: a study of hip fracture prediction in three cohorts
Quantitating age-related BMD textural variation from DXA region-free-analysis: a study of hip fracture prediction in three cohorts
The risk of osteoporotic fracture is inversely related to bone mineral density (BMD), but how spatial BMD pattern influences fracture risk remains incompletely understood. This study used a pixel-level spatiotemporal atlas of proximal femoral BMD in 13,338 white European women (age 20–97 years) to quantitate age-related texture variation in BMD maps and generate a “reference” map of bone aging. We introduce a new index, called Densitometric Bone Age (DBA), as the age at which an individual site-specific BMD map (the proximal femur is studied here) best matches the median aging trajectory at that site in terms of the root mean squared error (RMSE). The ability of DBA to predict incident hip fracture and hip fracture pattern over 5 years following baseline BMD was compared against conventional region-based BMD analysis in a subset of 11,899 women (age 45–97 years), for which follow-up fracture records exist. There were 208 subsequent incident hip fractures in the study populations (138 femoral necks [FNs], 52 trochanteric [TR], 18 sites unspecified). DBA had modestly better performance compared to the conventional FN-BMD, TR-BMD, and total hip (TOT)-BMD in identifying hip fractures measured as the area under the curve (AUC) using receiver operating characteristics (ROC) curve analysis by 2% (95% confidence interval [CI], −0.5% to 3.5%), 3% (95% CI, 1.0% to 4.0%), and 1% (95% CI, 0.4% to 1.6%), respectively. Compared to FN-BMD T-score, DBA improved the ROC-AUC for predicting TR fractures by ~5% (95% CI, 1.1% to 9.8%) with similar performance in identifying FN fractures. Compared to TR-BMD T-score, DBA improved the ROC-AUC for the prediction of FN fractures by ~3% (95% CI, 1.1% to 4.9%), with similar performance in identifying TR fractures. Our findings suggest that DBA may provide a spatially sensitive measure of proximal femoral fragility that is not captured by FN-BMD or TR-BMD alone. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
AGING, BMD, DXA, HIP FRACTURES, OSTEOPOROSIS
0884-0431
Farzi, Mohsen
9613d93d-9b21-4826-9509-f1e6013ce697
Pozo, Jose M.
2b76a97b-f65c-4b4b-92b0-d1242addd2be
McCloskey, Eugene
6d3df4aa-b438-4a83-bd06-06b6cbe3980f
Eastell, Richard
b19615e4-bc97-4ddf-b8d7-7f48b7220228
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Frangi, Alejandro
35127be7-3586-4fff-a4a2-bb79cc228141
Wilkinson, Jeremy Mark
0b233f4c-17db-47b2-884a-f04ac9c7cd02
Farzi, Mohsen
9613d93d-9b21-4826-9509-f1e6013ce697
Pozo, Jose M.
2b76a97b-f65c-4b4b-92b0-d1242addd2be
McCloskey, Eugene
6d3df4aa-b438-4a83-bd06-06b6cbe3980f
Eastell, Richard
b19615e4-bc97-4ddf-b8d7-7f48b7220228
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Frangi, Alejandro
35127be7-3586-4fff-a4a2-bb79cc228141
Wilkinson, Jeremy Mark
0b233f4c-17db-47b2-884a-f04ac9c7cd02

Farzi, Mohsen, Pozo, Jose M., McCloskey, Eugene, Eastell, Richard, Harvey, Nicholas, Frangi, Alejandro and Wilkinson, Jeremy Mark (2022) Quantitating age-related BMD textural variation from DXA region-free-analysis: a study of hip fracture prediction in three cohorts. Journal of Bone and Mineral Research. (doi:10.1002/jbmr.4638).

Record type: Article

Abstract

The risk of osteoporotic fracture is inversely related to bone mineral density (BMD), but how spatial BMD pattern influences fracture risk remains incompletely understood. This study used a pixel-level spatiotemporal atlas of proximal femoral BMD in 13,338 white European women (age 20–97 years) to quantitate age-related texture variation in BMD maps and generate a “reference” map of bone aging. We introduce a new index, called Densitometric Bone Age (DBA), as the age at which an individual site-specific BMD map (the proximal femur is studied here) best matches the median aging trajectory at that site in terms of the root mean squared error (RMSE). The ability of DBA to predict incident hip fracture and hip fracture pattern over 5 years following baseline BMD was compared against conventional region-based BMD analysis in a subset of 11,899 women (age 45–97 years), for which follow-up fracture records exist. There were 208 subsequent incident hip fractures in the study populations (138 femoral necks [FNs], 52 trochanteric [TR], 18 sites unspecified). DBA had modestly better performance compared to the conventional FN-BMD, TR-BMD, and total hip (TOT)-BMD in identifying hip fractures measured as the area under the curve (AUC) using receiver operating characteristics (ROC) curve analysis by 2% (95% confidence interval [CI], −0.5% to 3.5%), 3% (95% CI, 1.0% to 4.0%), and 1% (95% CI, 0.4% to 1.6%), respectively. Compared to FN-BMD T-score, DBA improved the ROC-AUC for predicting TR fractures by ~5% (95% CI, 1.1% to 9.8%) with similar performance in identifying FN fractures. Compared to TR-BMD T-score, DBA improved the ROC-AUC for the prediction of FN fractures by ~3% (95% CI, 1.1% to 4.9%), with similar performance in identifying TR fractures. Our findings suggest that DBA may provide a spatially sensitive measure of proximal femoral fragility that is not captured by FN-BMD or TR-BMD alone. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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More information

Accepted/In Press date: 17 June 2022
e-pub ahead of print date: 24 June 2022
Keywords: AGING, BMD, DXA, HIP FRACTURES, OSTEOPOROSIS

Identifiers

Local EPrints ID: 467901
URI: http://eprints.soton.ac.uk/id/eprint/467901
ISSN: 0884-0431
PURE UUID: b4daec2c-34f9-43ca-9f26-7c127cb36814
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 25 Jul 2022 16:32
Last modified: 30 Jul 2022 01:39

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Contributors

Author: Mohsen Farzi
Author: Jose M. Pozo
Author: Eugene McCloskey
Author: Richard Eastell
Author: Nicholas Harvey ORCID iD
Author: Alejandro Frangi
Author: Jeremy Mark Wilkinson

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