Terzini Mara, Aldieri Alessandra, Rinaudo Luca, Osella Giangiacomo, Audenino Alberto L, Bignardi Cristina
PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
TECHNOLOGIC S.r.l. Hologic Italia, Turin, Italy.
Front Bioeng Biotechnol. 2019 Sep 10;7:220. doi: 10.3389/fbioe.2019.00220. eCollection 2019.
Osteoporotic fracture incidence represents a major social and economic concern in the modern society, where the progressive graying of the population involves an highly increased fracture occurrence. Although the gold standard to diagnose osteoporosis is represented by the T-score measurement, estimated from the Bone Mineral Density (BMD) using Dual-energy X-ray Absorptiometry (DXA), the identification of the subjects at high risk of fracture still remains an issue. From this perspective, the purpose of this work is to investigate the role that DXA-based two-dimensional patient-specific finite element (FE) models of the proximal femur, in combination with T-score, could play in enhancing the risk of fracture estimation. With this aim, 2D FE models were built from DXA images of the 28 post-menopausal female subjects involved. A sideways fall condition was reproduced and a Risk of Fracture ( ) was computed on the basis of principal strains criteria. The identified was then compared to that derived from the CT-based models developed in a previous study. The 2D and 3D turned out to be significantly correlated (Spearman's ρ = 0.66, < 0.001), highlighting the same patients as those at higher risk. Moreover, the 2D resulted significantly correlated with the T-score (Spearman's ρ = -0.69, < 0.001), and managed to better differentiate osteopenic patients, drawing the attention to some of them. The Hip Structural Analysis (HSA) variables explaining the majority of the variance of the 2D and 3D fracture risk were the same as well, i.e., neck-shaft angle and narrow neck buckling ratio. In conclusion, DXA-based FE models, developable from currently available clinical data, appear promising in supporting and integrating the present diagnostic procedure.
骨质疏松性骨折的发生率是现代社会的一个主要社会和经济问题，在现代社会中，人口老龄化进程导致骨折发生率大幅上升。尽管诊断骨质疏松症的金标准是通过双能X线吸收法（DXA）测量骨矿物质密度（BMD）得出的T值，但识别骨折高危人群仍然是一个问题。从这个角度来看，这项工作的目的是研究基于DXA的股骨近端二维患者特异性有限元（FE）模型与T值相结合在提高骨折风险评估方面可能发挥的作用。为此，从28名绝经后女性受试者的DXA图像构建了二维FE模型。模拟了侧方跌倒情况，并根据主应变标准计算了骨折风险（ ）。然后将识别出的 与先前研究中基于CT模型得出的结果进行比较。结果发现二维和三维 显著相关（Spearman相关系数ρ = 0.66， < 0.001），突出显示了相同的高危患者。此外，二维 与T值显著相关（Spearman相关系数ρ = -0.69， < 0.001），并且能够更好地区分骨质减少患者，引起了对其中一些患者的关注。解释二维和三维骨折风险大部分方差的髋部结构分析（HSA）变量也是相同的，即颈干角和窄颈屈曲比。总之，基于DXA的有限元模型可以从现有的临床数据中开发出来，在支持和整合当前诊断程序方面似乎很有前景。
