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Predictive ability of novel volumetric and geometric indices derived from dual-energy X-ray absorptiometric images of the proximal femur for hip fracture compared with conventional areal bone mineral density: the Japanese Population-based Osteoporosis (JPOS) Cohort Study

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Abstract

Summary

Areal BMD (aBMD) from DXA is not a sufficiently accurate predictor of fracture. Novel volumetric BMD derived from 3D modeling of the hip from DXA images significantly improved the predictive ability for hip fracture relative to aBMD at the femoral neck, but not aBMD at the total hip.

Introduction

To clarify whether volumetric and geometric indices derived from novel three-dimensional (3D) modeling of the hip using dual-energy X-ray absorptiometric (DXA) images improve hip fracture prediction relative to areal bone mineral density (aBMD).

Methods

We examined 1331 women who had completed the baseline survey and at least one follow-up survey over 20 years (age 40–79 years at baseline). Each survey included aBMD measurement at the hip by DXA. Volumetric and geometric indices of the hip at baseline and the 10-year follow-up were estimated from DXA images using a 3D modeling algorithm. Incident hip fractures during the 20-year follow-up period were identified through self-report. Cox proportional hazards regression models allowing for repeated measurements of predictors and outcomes were constructed, and their predictive ability for hip fracture was evaluated using areas under receiver operating characteristic curves (AUCs) and net reclassification improvement (NRI) over aBMD at the femoral neck (FN) and total hip (TH) as references.

Results

During a median follow-up of 19.8 years, 68 incident hip fractures were identified (2.22/1000 person-years). A significantly larger AUC of trabecular volumetric BMD (vBMD) at the total hip (AUC = 0.741), femoral neck (AUC = 0.748), and intertrochanter (AUC = 0.738) and significant NRI (0.177, 0.149, and 0.195, respectively) were observed compared with FN-aBMD (AUC = 0.701), but not TH-aBMD.

Conclusions

vBMD obtained from 3D modeling using routinely obtained hip DXA images significantly improved hip fracture risk prediction over conventional FN-aBMD, but not TH-aBMD.

Trial registration

The Japanese Population-Based Osteoporosis (JPOS) Cohort Study was retrospectively registered as UMIN000032869 in the UMIN Clinical Trials Registry on July 1, 2018.

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Data availability

Data will be made available on request.

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Acknowledgements

This study represents a part of the research conducted by the Japanese Population-Based Osteoporosis study group (Chairman, Masayuki Iki), comprising Fumiaki Marumo (former chairman, Tokyo Medical and Dental University), Toshihisa Matsuzaki (former cochairman, University of the Ryukyus), Hideo Yoneshima (former chairman, Shuwa General Hospital), Yoshiko Kagawa (Kagawa Nutrition University), Takashi Akiba (Tokyo Women’s Medical University), Harumi Nishino (Toyama Pharmaceutical Association), Tomoharu Matsukura (Toyama Prefectural Government), Toshio Matsumoto (University of Tokushima), Takashi Yamagami (Hokuriku Health Service Association), and Jun Kitagawa (Kitasato University), in addition to the authors. The authors thank the personnel of the health departments of Memuro town, Joetsu city, Nishi-Aizu town, Sanuki city, and Miyako-jima city for their support. The authors also thank the personnel from SRL, Tokyo, Japan; Toyo Medic, Osaka, Japan; Toyukai Medical Corporation, Tokyo, Japan; and Take Medical Service, Tokyo, Japan for their technical assistance with the surveys.

Code availability

Codes for data analysis will be made available on request.

Funding

Financial support for the baseline survey was provided by the Japan Milk Promotion Board and the Japan Dairy Council. Follow-up surveys were financially supported by JSPS KAKENHI (Grant Numbers 10470114, 14370147, 18390201, 18590619, 23390180, 23590824, 23657176, 15H02526, 15H04789, 15H05102, 16K19263, 16K15360, 17K09141, and 18K19711) from the Japan Society for the Promotion of Sciences, a grant from the Research Society for Metabolic Bone Diseases (2000–2002), a Grant-in-Aid to Study Milk Nutrition (2006, 2011, 2015, 2016) from the Japan Dairy Association, a Grant-in-Aid (2011) from the Univers Foundation, and a Young Scientist Award (2016) from the Japan Osteoporosis Society. The funding bodies had no role in designing the study, collecting, analyzing, or interpreting the data, writing the manuscript, or deciding where to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    M. Iki & A. Yura

  2. 3D-SHAPER Medical SL, Carrer de París, 179 2° 2ª, 08036, Barcelona, Spain

    R. Winzenrieth

  3. Department of Hygiene and Public Health, Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan

    J. Tamaki & K. Kamiya

  4. Department of Human Life, Jin-ai University, 3-1-1 Otemachi, Echizen, Fukui, 915-8586, Japan

    Y. Sato

  5. Department of Orthopedics Medicine, The Second Affiliated Hospital, Inner Mongolia Medical University, No.1 Yingfang Road, Huimin District, Hohhot, 010030, China

    N. Dongmei

  6. Chukyo Gakuin University Faculty of Nursing, 2216 Tokicho, Mizunami, Gifu, 509-6192, Japan

    E. Kajita & T. Tachiki

  7. Department of Hygiene and Public Health, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan

    K. Kouda

  8. University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan

    S. Kagamimori

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  1. M. Iki
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Corresponding author

Correspondence to M. Iki.

Ethics declarations

Ethics approval

The study protocol was approved by the Ethics Committee of the Kindai University Faculty of Medicine (#30-133).

Consent to participate

All participants provided written informed consent prior to participation in the baseline and follow-up surveys.

Consent for publication

Publication of the present manuscript has been approved by all authors.

Conflict of interest

Renaud Winzenrieth is Clinical Manager at 3D-SHAPER Medical SL. Masayuki Iki, Junko Tamaki, Yuho Sato, Namiraa Dongmei, Etsuko Kajita, Katsuyasu Kouda, Akiko Yura, Takahiro Tachiki, Kuniyasu Kamiya, and Sadanobu Kagamimori declare that they have no conflict of interest.

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Iki, M., Winzenrieth, R., Tamaki, J. et al. Predictive ability of novel volumetric and geometric indices derived from dual-energy X-ray absorptiometric images of the proximal femur for hip fracture compared with conventional areal bone mineral density: the Japanese Population-based Osteoporosis (JPOS) Cohort Study. Osteoporos Int 32, 2289–2299 (2021). https://doi.org/10.1007/s00198-021-06013-2

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