Analyzing the effect of osteoporosis drug treatments on femoral strength using 3D-DXA finite elements modelling.

Osteoporotic hip fracture represents a high social and economic burden in western countries. Pharmacological treatments aim to limit/reverse the loss of bone mineral density (BMD). BMD is monitored through dual energy X-ray absorptiometry (DXA). Biomechanical analysis, through 3D-DXA finite element (FE) femur models, has been shown to potentially improve fracture risk prediction. Yet, the capability of 3D-DXA FE simulations to capture the effects of pharmacological treatments on bone strength remains unexplored. Thus, this study aims to evaluate simulated changes in bone strength in subjects with different osteoporosis treatments using 3D-DXA FE models. A cohort of 155 subjects was used to generate the patient-specific FE models. Osteoporosis treatments included Alendronate (AL, n = 54), Denosumab (DMAB, n = 33), Teriparatide (TPTD, n = 31), and Naïve (NAÏVE, n = 37). Bone was modelled as BMD-dependent elasto-plastic material. Lateral fall was simulated, and bone FE-strength changes from baseline were assessed. Integral FE-strength significantly increased by 3.1% and 4.0% in the AL and DMAB groups, respectively. Trabecular and cortical FE-strength significantly increased by 2.2% and 1.9%, respectively with DMAB. Load-bearing capacity increased in both the cortical and trabecular bone of the femoral neck with DMAB and AL, while it only increased in the trabecular bone with TPTD. 3D-DXA FE analysis might help clinicians to better monitor the effects of pharmacological treatments and potentially improve personalised treatment plans for subjects with osteoporosis.