基于 DXA 扫描的有限元分析评估股骨强度与男性骨质疏松性骨折研究（MrOS）中发生髋部骨折的关系。
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.
机构信息
Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.
INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK.
出版信息
Osteoporos Int. 2018 Mar;29(3):643-651. doi: 10.1007/s00198-017-4319-2. Epub 2017 Nov 22.
UNLABELLED
Finite element model can estimate bone strength better than BMD. This study used such a model to determine its association with hip fracture risk and found that the strength estimate provided limited improvement over the hip BMDs in predicting femoral neck (FN) fracture risk only.
INTRODUCTION
Bone fractures occur only when it is loaded beyond its ultimate strength. The goal of this study was to determine the association of femoral strength, as estimated by finite element (FE) analysis of DXA scans, with incident hip fracture as a single condition or with femoral neck (FN) and trochanter (TR) fractures separately in older men.
METHODS
This prospective case-cohort study included 91 FN and 64 TR fracture cases and a random sample of 500 men (14 had a hip fracture) from the Osteoporotic Fractures in Men study during a mean ± SD follow-up of 7.7 ± 2.2 years. We analysed the baseline DXA scans of the hip using a validated plane-stress, linear-elastic FE model of the proximal femur and estimated the femoral strength during a sideways fall.
RESULTS
The estimated strength was significantly (P < 0.05) associated with hip fracture independent of the TR and total hip (TH) BMDs but not FN BMD, and combining the strength with BMD did not improve the hip fracture prediction. The strength estimate was associated with FN fractures independent of the FN, TR and TH BMDs; the age-BMI-BMD adjusted hazard ratio (95% CI) per SD decrease of the strength was 1.68 (1.07-2.64), 2.38 (1.57, 3.61) and 2.04 (1.34, 3.11), respectively. This association with FN fracture was as strong as FN BMD (Harrell's C index for the strength 0.81 vs. FN BMD 0.81) and stronger than TR and TH BMDs (0.8 vs. 0.78 and 0.81 vs. 0.79). The strength's association with TR fracture was not independent of hip BMD.
CONCLUSIONS
Although the strength estimate provided additional information over the hip BMDs, its improvement in predictive ability over the hip BMDs was confined to FN fracture only and limited.
目的
骨强度可以通过有限元模型（FE）来估计，优于骨密度（BMD）。本研究采用该模型来确定其与髋部骨折风险的关系，结果发现，该强度估计值仅在预测股骨颈（FN）骨折风险方面，相较于髋部 BMD 提供了有限的改善。
简介
只有当骨骼承受的负荷超过其极限强度时才会发生骨折。本研究的目的是确定通过 DXA 扫描的 FE 分析估计的股骨强度与老年男性中作为单一条件的髋部骨折或股骨颈（FN）和转子间（TR）骨折的关系。
方法
这项前瞻性病例队列研究纳入了 91 例 FN 骨折和 64 例 TR 骨折病例，以及来自男性骨质疏松性骨折研究（Osteoporotic Fractures in Men study）的 500 名男性的随机样本（14 人发生了髋部骨折），平均随访 7.7±2.2 年。我们使用经过验证的股骨近端平面应变、线弹性 FE 模型分析了髋部的基线 DXA 扫描，并估计了在侧方跌倒时的股骨强度。
结果
在调整年龄、BMI 和 BMD 后，估计的强度与髋部骨折显著相关（P<0.05），与转子间和全髋 BMD 无关，但与股骨颈 BMD 无关，且将强度与 BMD 结合并未改善髋部骨折的预测。强度估计与 FN 骨折独立相关，与 FN、TR 和全髋 BMD 无关；强度每降低一个标准差，年龄-BMI-BMD 调整后的危险比（95%CI）分别为 1.68（1.07-2.64）、2.38（1.57-3.61）和 2.04（1.34-3.11）。与 FN 骨折的这种关联与 FN BMD 一样强（强度的 Harrell's C 指数为 0.81，与 FN BMD 为 0.81），且比转子间和全髋 BMD 更强（0.8 与 0.78，0.81 与 0.79）。强度与 TR 骨折的关系与髋部 BMD 无关。
结论
尽管强度估计值提供了髋部 BMD 之外的其他信息，但它对髋部 BMD 的预测能力的改善仅限于 FN 骨折，且改善程度有限。
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