The application of finite element modelling based on clinical pQCT for classification of fracture status
- 69 Downloads
Fracture risk assessment using dual-energy X-ray absorptiometry (DXA) frequently fails to diagnose osteoporosis amongst individuals who later experience fragility fractures. Hence, more reliable techniques that improve the prediction of fracture risk are needed. In this study, we evaluated a finite element (FE) modelling framework based on clinical peripheral quantitative computed tomography (pQCT) imaging of the tibial epiphysis and diaphysis to predict the stiffness at these locations in compression, shear, torsion and bending. The ability of these properties to identify a group of women who had recently sustained a low-trauma fracture from an age- and weight-matched control group was determined and compared to clinical pQCT and DXA properties and structural properties based on composite beam theory. The predicted stiffnesses derived from the FE models and composite beam theory were significantly different (p < 0.05) between the control and fracture groups, whereas no meaningful differences were observed using DXA and for the stress–strain indices (SSIs) derived using pQCT. The diagnostic performance of each property was assessed by the odds ratio (OR) and the area under the receiver operating curve (AUC), and both were greatest for the FE-predicted shear stiffness (OR 16.09, 95% CI 2.52–102.56, p = 0.003) (AUC: 0.80, 95% CI 0.67–0.93). The clinical pQCT variable total density (ρtot) and a number of structural and FE-predicted variables had a similar probability of correct classification between the control and fracture groups (i.e. ORs and AUCs with mean values greater than 5.00 and 0.80, respectively). In general, the diagnostic characteristics were lower for variables derived using DXA and for the SSIs (i.e. ORs and AUCs with mean values of 1.65–2.98 and 0.64–0.71, respectively). For all properties considered, the trabecular-dominant tibial epiphysis exhibited enhanced classification characteristics, as compared to the cortical-dominant tibial diaphysis. The results of this study demonstrate that bone properties may be derived using FE modelling that have the potential to enhance fracture risk assessment using conventional pQCT or DXA instruments in clinical settings.
KeywordspQCT FE modelling Fracture status Bone strength
We thank all participants for consenting to provide their pQCT tibia scan data for this study. We duly acknowledge Ashwini Kale for diligently performing all pQCT scans, Richard Farrugia for facilitating patient recruitment and clinic coordination activities and Associate Professor Andrew Bucknill for his strong support of the Royal Melbourne Hospital fracture liaison service. This work was supported by a collaborative PhD scholarship provided by the University of Melbourne and the China Scholarship Council to HJ.
- Briggs AM, Perilli E, Parkinson IH, Wrigley TV, Fazzalari NL, Kantor S, Wark JD (2010) Novel assessment of subregional bone mineral density using DXA and PQCT and subregional microarchitecture using micro-CT in whole human vertebrae: applications, methods, and correspondence between technologies. J Clin Densitom 13(2):161–174CrossRefGoogle Scholar
- Engelke K, Adams JE, Armbrecht G, Augat P, Bogado CE, Bouxsein ML, Felsenberg D, Ito M, Prevrhal S, Hans DB, Lewiecki EM (2008) Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD official positions. J Clin Densitom 11(1):123–162CrossRefGoogle Scholar
- Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Glüer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, Van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18(8):1033–1046CrossRefGoogle Scholar
- Kontulainen SA, Johnston JD, Liu D, Leung C, Oxland TR, McKay HA (2008) Strength indices from PQCT imaging predict up to 85% of variance in bone failure properties at tibial epiphysis and diaphysis. J Musculoskelet Neuronal Interact 8(4):401–409Google Scholar
- Liu XS, Zhang XH, Sekhon KK, Adams MF, McMahon DJ, Bilezikian JP, Shane E, Guo XE (2010) High-resolution peripheral quantitative computed tomography can assess microstructural and mechanical properties of human distal tibial bone. J Bone Miner Res 25(4):746–756Google Scholar
- Liu XS, Stein EM, Zhou B, Zhang CA, Nickolas TL, Cohen A, Thomas V, McMahon DJ, Cosman F, Nieves J et al (2012) Individual trabecula segmentation (ITS)-based morphological analyses and microfinite element analysis of HR-PQCT images discriminate postmenopausal fragility fractures independent of DXA measurements. J Bone Miner Res 27(2):263–272CrossRefGoogle Scholar
- Nazrun AS, Tzar MN, Mokhtar SA, Mohamed IN (2014) A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and mortality. Ther Clin Risk Manag 10:937–948Google Scholar
- Ringle CM, Wende S, Becker J-M (2015) SmartPLS 3. Boenningstedt SmartPLS GmbH. www.smartpls.com. Accessed 9 July 2018
- Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the national osteoporosis risk assessment. JAMA 286(22):2815–2822CrossRefGoogle Scholar
- Snyder BD, Hauser-Kara DA, Hipp JA, Zurakowski D, Hecht AC, Gebhardt MC (2006) Predicting fracture through Benign skeletal lesions with quantitative computed tomography. J Bone Jt Surg 88–A(1):55–70Google Scholar
- Zysset PK, Dall’Ara E, Varga P, Pahr DH (2013) Finite element analysis for prediction of bone strength. Bonekey Rep 2(AUGUST):1–9Google Scholar