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

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Abstract

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.

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Data availability

All data are available on request to the corresponding author.

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Author information

Author notes

  1. F. M. Ulivieri

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

Authors and Affiliations

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

    C. Messina & L. M. Sconfienza

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

    C. Messina, L. M. Sconfienza & F. Sardanelli

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

    L. Rinaudo

  4. Unità 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

    B. M. Cesana

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

    D. Maresca

  6. Milano, Italy

    L. P. Piodi

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

    F. Sardanelli

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

    F. M. Ulivieri

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  1. C. Messina
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Corresponding author

Correspondence to F. M. Ulivieri.

Ethics declarations

Local Ethical Committee approvals were obtained by each Hospital (Comitato Etico Milano Area 2. Protocol N 2.0 BQ. 265_2017, 13th June 2017; Comitato Etico San Raffaele; Studio clinico 2.0 BQ, version 4.0, 8th August 2019).

Conflict of interest

All authors have no competing interests. The engineer LR, formerly working in Politecnico of Turin and now employed at the commercial company “TECHNOLOGIC S.r.l”, has extracted and tabulated the densitometric data and has applied the mathematical algorithms based on the finite element analysis to calculate the Bone Strain Index. TECHNOLOGIC S.r.l. provided support in the form of salary for LR, but did not have any role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Messina, C., Rinaudo, L., Cesana, B.M. et al. Prediction of osteoporotic fragility re-fracture with lumbar spine DXA-based derived bone strain index: a multicenter validation study. Osteoporos Int 32, 85–91 (2021). https://doi.org/10.1007/s00198-020-05620-9

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