Trial reportJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2014
Prediction of incident hip fracture with the estimated femoral strength by finite element analysis of DXA Scans in the study of osteoporotic fractures.
Trial report in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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Who cites it
26 citing papers in PubMed.
- Future Osteoporotic Fracture Risk Related to Lumbar Vertebral Trabecular Attenuation Measured at Routine Body CT.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2018Trial
- HR-pQCT skeletal phenotype clustering associated with muscle function in older men and women: The Study of Muscle, Mobility and Aging (SOMMA).Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2026Article
- Advances in Imaging-Based Fracture Risk Assessment for Unlocking Latent Skeletal Fragility.Current osteoporosis reports · 2026Review
- Diagnosis and treatment of Pipkin type IV femoral head fracture : a finite element analysis.BMC musculoskeletal disorders · 2026Article
- Article
- Inelastic mechanical descriptors for osteoporotic hip fracture discrimination with 3D-DXA-based nonlinear finite element models.Frontiers in bioengineering and biotechnology · 2025Article
- Parametrized statistical appearance and shape modelling strategy to predict proximal and diaphyseal femoral fractures.Frontiers in bioengineering and biotechnology · 2025Article
- Article
- The Bone Strain Index: An Innovative Dual X-ray Absorptiometry Bone Strength Index and Its Helpfulness in Clinical Medicine.Journal of clinical medicine · 2022Review
- Differences in Hip Geometry Between Female Subjects With and Without Acute Hip Fracture: A Cross-Sectional Case-Control Study.Frontiers in endocrinology · 2022Article
- On challenges in clinical assessment of hip fracture risk using image-based biomechanical modelling: a critical review.Journal of bone and mineral metabolism · 2021Review
- Bone strain index as a predictor of further vertebral fracture in osteoporotic women: An artificial intelligence-based analysis.PloS one · 2021Article
- Perspectives on the non-invasive evaluation of femoral strength in the assessment of hip fracture risk.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2020Article
- Beyond Bone Mineral Density: A New Dual X-Ray Absorptiometry Index of Bone Strength to Predict Fragility Fractures, the Bone Strain Index.Frontiers in medicine · 2020Review
- Risk Assessment of Hip Fracture Based on Machine Learning.Applied bionics and biomechanics · 2020Article
- Bone Mineral Density and Bone Turnover Markers in Postmenopausal Women Subjected to an Aqua Fitness Training Program.International journal of environmental research and public health · 2019Article
- Article
- Improving the Hip Fracture Risk Prediction Through 2D Finite Element Models From DXA Images: Validation Against 3D Models.Frontiers in bioengineering and biotechnology · 2019Article
- Association of incident hip fracture with the estimated femoral strength by finite element analysis of DXA scans in the Osteoporotic Fractures in Men (MrOS) study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2018Article
- Automated DXA-based finite element analysis for hip fracture risk stratification: a cross-sectional study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2018Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
A bone fractures only when loaded beyond its strength. The purpose of this study was to determine the association of femoral strength, as estimated by finite element (FE) analysis of dual-energy X-ray absorptiometry (DXA) scans, with incident hip fracture in comparison to hip bone mineral density (BMD), Fracture Risk Assessment Tool (FRAX), and hip structure analysis (HSA) variables. This prospective case-cohort study included a random sample of 1941 women and 668 incident hip fracture cases (295 in the random sample) during a mean ± SD follow-up of 12.8 ± 5.7 years from the Study of Osteoporotic Fractures (n = 7860 community-dwelling women ≥67 years of age). We analyzed the baseline DXA scans (Hologic 1000) of the hip using a validated plane-stress, linear-elastic finite element (FE) model of the proximal femur and estimated the femoral strength during a simulated sideways fall. Cox regression accounting for the case-cohort design assessed the association of estimated femoral strength with hip fracture. The age-body mass index (BMI)-adjusted hazard ratio (HR) per SD decrease for estimated strength (2.21; 95% CI, 1.95-2.50) was greater than that for total hip (TH) BMD (1.86; 95% CI, 1.67-2.08; p < 0.05), FN BMD (2.04; 95% CI, 1.79-2.32; p > 0.05), FRAX scores (range, 1.32-1.68; p < 0.0005), and many HSA variables (range, 1.13-2.43; p < 0.005), and the association was still significant (p < 0.05) after further adjustment for hip BMD or FRAX scores. The association of estimated strength with incident hip fracture was strong (Harrell's C index 0.770), significantly better than TH BMD (0.759; p < 0.05) and FRAX scores (0.711-0.743; p < 0.0001), but not FN BMD (0.762; p > 0.05). Similar findings were obtained for intracapsular and extracapsular fractures. In conclusion, the estimated femoral strength from FE analysis of DXA scans is an independent predictor and performs at least as well as FN BMD in predicting incident hip fracture in postmenopausal women.
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