Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Mechanical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada.
J Clin Densitom. 2019 Jul-Sep;22(3):338-345. doi: 10.1016/j.jocd.2019.02.001. Epub 2019 Feb 8.
OBJECTIVE: Finite element analysis (FEA) is a computational method to predict the behavior of materials under applied loading. We developed a software tool that automatically performs FEA on dual-energy X-ray absorptiometry hip scans to generate site-specific fracture risk indices (FRIs) that reflect the likelihood of hip fracture from a sideways fall. This longitudinal study examined associations between FRIs and incident fractures. METHODS: Using the Manitoba Bone Mineral Density (BMD) Registry, femoral neck (FN), intertrochanter (IT), and subtrochanter (ST) FRIs were automatically derived from 13,978 anonymized dual-energy X-ray absorptiometry scans (Prodigy, GE Healthcare) in women and men aged 50 yr or older (mean age 65 yr). Baseline covariates and incident fractures were assessed from population-based data. We compared c-statistics for FRIs vs FN BMD alone and fracture risk assessment (FRAX) probability computed with BMD. Cox regression was used to estimate hazard ratios and 95% confidence intervals (95% CIs) for incident hip, major osteoporotic fracture (MOF) and non-hip MOF adjusted for relevant covariates including age, sex, FN BMD, FRAX probability, FRAX risk factors, and hip axis length (HAL). RESULTS: During mean follow-up of 6 yr, there were 268 subjects with incident hip fractures, 1003 with incident MOF, and 787 with incident non-hip MOF. All FRIs gave significant stratification for hip fracture (c-statistics FN-FRI: 0.76, 95% CI 0.73-0.79, IT-FRI 0.74, 0.71-0.77; ST-FRI 0.72, 0.69-0.75). FRIs continued to predict hip fracture risk even after adjustment for age and sex (hazard ratio per standard deviation FN-FRI 1.89, 95% CI 1.66-2.16); age, sex, and BMD (1.26, 1.07-1.48); FRAX probability (1.30, 1.11-1.52); FRAX probability with HAL (1.26, 1.05-1.51); and individual FRAX risk factors (1.32, 1.09-1.59). FRIs also predicted MOF and non-hip MOF, but the prediction was not as strong as for hip fracture. SUMMARY: Automatically-derived FN, IT, and ST FRIs are associated with incident hip fracture independent of multiple covariates, including FN BMD, FRAX probability and risk factors, and HAL.
目的：有限元分析（FEA）是一种预测材料在施加载荷下行为的计算方法。我们开发了一种软件工具，可自动对双能 X 射线吸收法髋部扫描进行 FEA，以生成特定部位的骨折风险指数（FRI），反映从侧面跌倒导致髋部骨折的可能性。这项纵向研究检查了 FRI 与骨折事件之间的关联。
方法：使用马尼托巴省骨密度（BMD）登记处，从年龄在 50 岁或以上的 13978 名女性和男性的匿名双能 X 射线吸收法扫描（Prodigy，GE Healthcare）中自动得出股骨颈（FN）、转子间（IT）和转子下（ST）FRI。从基于人群的数据中评估基线协变量和骨折事件。我们比较了 FRI 与 FN BMD 单独评估和使用 BMD 计算的骨折风险评估（FRAX）概率的 C 统计量。使用 Cox 回归估计调整年龄、性别、FN BMD、FRAX 概率、FRAX 风险因素和髋轴长度（HAL）等相关协变量后，髋部、主要骨质疏松性骨折（MOF）和非髋部 MOF 事件的风险比和 95%置信区间（95%CI）。
结果：在平均 6 年的随访期间，有 268 名受试者发生髋部骨折，1003 名发生 MOF，787 名发生非髋部 MOF。所有 FRI 对髋部骨折均有显著分层作用（FN-FRI 的 C 统计量为 0.76，95%CI 为 0.73-0.79，IT-FRI 为 0.74，0.71-0.77；ST-FRI 为 0.72，0.69-0.75）。即使在调整年龄和性别后，FRI 仍继续预测髋部骨折风险（FN-FRI 每标准差增加 1.89，95%CI 为 1.66-2.16）；年龄、性别和 BMD（1.26，1.07-1.48）；FRAX 概率（1.30，1.11-1.52）；FRAX 概率与 HAL（1.26，1.05-1.51）；和个体 FRAX 风险因素（1.32，1.09-1.59）。FRI 还预测了 MOF 和非髋部 MOF，但预测效果不如髋部骨折。
总结：自动得出的 FN、IT 和 ST FRI 与髋部骨折事件相关，独立于多个协变量，包括 FN BMD、FRAX 概率和风险因素以及 HAL。
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