ArticleJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2018
Osteoporosis and Hip Fracture Risk From Routine Computed Tomography Scans: The Fracture, Osteoporosis, and CT Utilization Study (FOCUS).
Article in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 6 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
55 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- The 2024 UK clinical guideline for the prevention and treatment of osteoporosis.Archives of osteoporosis · 2025Guideline
- National guidelines for diagnosis and treatment of osteoporosis in Slovakia.Archives of osteoporosis · 2025Guideline
- [Osteoporosis-Definition, risk assessment, diagnosis, prevention and treatment (update 2024) : Guidelines of the Austrian Society for Bone and Mineral Research].Wiener klinische Wochenschrift · 2024Guideline
- CT image-based biomarkers for opportunistic screening of osteoporotic fractures: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Pooled it
- Segmentation methods for quantifying X-ray Computed Tomography based biomarkers to assess hip fracture risk: a systematic literature review.Frontiers in bioengineering and biotechnology · 2024Pooled it
- UK clinical guideline for the prevention and treatment of osteoporosis.Archives of osteoporosis · 2022Guideline
- Article
- Assessing bone microstructure and density with photon-counting CT: emerging applications and challenges.Skeletal radiology · 2026Review
- Investigating the Influence of Limited CT Scan Coverage Using an Automated Workflow with Biofidelic Sideways Fall FE Models.Annals of biomedical engineering · 2026Article
- Improved prediction of hip fracture using multi-faceted biomechanical computed tomography.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
- Psoas muscle mass measurement in assessment of imminent fracture risk after vertebral fracture: a single-center case-control study.BMC musculoskeletal disorders · 2026Article
- Relationship between areal BMD, FRAX®, and femoral strength in community-dwelling older Asian adults.Archives of osteoporosis · 2025Article
- Integration of Multi-Scale Predictive Tools of Bone Fragility: A Structural and Material Property Perspective.Materials (Basel, Switzerland) · 2025Review
- Can Multi-Vertebral CT-Based Finite Element Models Accurately Predict Strains? An In Vitro Validation Study.International journal for numerical methods in biomedical engineering · 2025Article
- Comparison of the time-dependent discriminatory accuracy of femoral strength and bone mineral density for predicting future hip and major osteoporotic fractures: a 16-year follow-up of the AGES-Reykjavik cohort.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Osteoporosis in Adult Patients Undergoing Spinal Reconstructive Surgery: Associated Complications and Management.Global spine journal · 2025Article
- Article
- Gender differences in L1 vertebral strength in adults 50+ using automated CT-based finite element analysis.Scientific reports · 2025Article
- Computer-aided diagnosis for China-Japan Friendship Hospital classification of necrotic femurs using statistical shape and appearance model based on CT scans.Medical & biological engineering & computing · 2025Article
Corrections and comments
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Authors and funding
11 authors.
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Abstract
Methods now exist for analyzing previously taken clinical computed tomography (CT) scans to measure a dual-energy X-ray absorptiometry (DXA)-equivalent bone mineral density (BMD) at the hip and a finite element analysis-derived femoral strength. We assessed the efficacy of this "biomechanical CT" (BCT) approach for identifying patients at high risk of incident hip fracture in a large clinical setting. Using a case-cohort design sampled from 111,694 women and men aged 65 or older who had a prior hip CT scan, a DXA within 3 years of the CT, and no prior hip fracture, we compared those with subsequent hip fracture (n = 1959) with randomly selected sex-stratified controls (n = 1979) and analyzed their CT scans blinded to all other data. We found that the age-, race-, and body mass index (BMI)-adjusted hazard ratio (HR; per standard deviation) for femoral strength was significant before (women: HR = 2.8, 95% confidence interval [CI] 2.2-3.5; men: 2.8, 2.1-3.7) and after adjusting also for the (lowest) hip BMD T-score by BCT (women: 2.1, 1.4-3.2; men: 2.7, 1.6-4.6). The hazard ratio for the hip BMD T-score was similar between BCT and DXA for both sexes (women: 2.1, 1.8-2.5 BCT versus 2.1, 1.7-2.5 DXA; men: 2.8, 2.1-3.8 BCT versus 2.5, 2.0-3.2 DXA) and was higher than for the (lowest) spine/hip BMD T-score by DXA (women: 1.6, 1.4-1.9; men: 2.1, 1.6-2.7). Compared with the latter as a clinical-practice reference and using both femoral strength and the hip BMD T-score from BCT, sensitivity for predicting hip fracture was higher for BCT (women: 0.66 versus 0.59; men: 0.56 versus 0.48), with comparable respective specificity (women: 0.66 versus 0.67; men: 0.76 versus 0.78). We conclude that BCT analysis of previously acquired routine abdominal or pelvic CT scans is at least as effective as DXA testing for identifying patients at high risk of hip fracture. © 2018 American Society for Bone and Mineral Research.
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