Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
3D-SHAPER Medical SL, Carrer de París, 179 2° 2ª, 08036, Barcelona, Spain.
Osteoporos Int. 2021 Nov;32(11):2289-2299. doi: 10.1007/s00198-021-06013-2. Epub 2021 May 26.
Areal BMD (aBMD) from DXA is not a sufficiently accurate predictor of fracture. Novel volumetric BMD derived from 3D modeling of the hip from DXA images significantly improved the predictive ability for hip fracture relative to aBMD at the femoral neck, but not aBMD at the total hip.
To clarify whether volumetric and geometric indices derived from novel three-dimensional (3D) modeling of the hip using dual-energy X-ray absorptiometric (DXA) images improve hip fracture prediction relative to areal bone mineral density (aBMD).
We examined 1331 women who had completed the baseline survey and at least one follow-up survey over 20 years (age 40-79 years at baseline). Each survey included aBMD measurement at the hip by DXA. Volumetric and geometric indices of the hip at baseline and the 10-year follow-up were estimated from DXA images using a 3D modeling algorithm. Incident hip fractures during the 20-year follow-up period were identified through self-report. Cox proportional hazards regression models allowing for repeated measurements of predictors and outcomes were constructed, and their predictive ability for hip fracture was evaluated using areas under receiver operating characteristic curves (AUCs) and net reclassification improvement (NRI) over aBMD at the femoral neck (FN) and total hip (TH) as references.
During a median follow-up of 19.8 years, 68 incident hip fractures were identified (2.22/1000 person-years). A significantly larger AUC of trabecular volumetric BMD (vBMD) at the total hip (AUC = 0.741), femoral neck (AUC = 0.748), and intertrochanter (AUC = 0.738) and significant NRI (0.177, 0.149, and 0.195, respectively) were observed compared with FN-aBMD (AUC = 0.701), but not TH-aBMD.
vBMD obtained from 3D modeling using routinely obtained hip DXA images significantly improved hip fracture risk prediction over conventional FN-aBMD, but not TH-aBMD.
The Japanese Population-Based Osteoporosis (JPOS) Cohort Study was retrospectively registered as UMIN000032869 in the UMIN Clinical Trials Registry on July 1, 2018.
非标注 BMD（aBMD）与 DXA 不具有足够的骨折预测准确性。从 DXA 图像的髋部 3D 模型中获得的新型容积 BMD 显著提高了相对于股骨颈的 aBMD 对髋部骨折的预测能力，但对全髋的 aBMD 没有提高。
为了明确是否使用双能 X 射线吸收法（DXA）图像对髋部进行新型三维（3D）建模所获得的容积和几何指标可改善髋部骨折的预测，相对于面积骨矿物质密度（aBMD）。
我们对 1331 名女性进行了研究，她们在 20 年的时间里完成了基线调查和至少一次随访调查（基线时年龄为 40-79 岁）。每次调查都包括使用 DXA 对髋部进行 aBMD 测量。使用 3D 建模算法从 DXA 图像中估算出髋部的容积和几何指数。在 20 年的随访期间，通过自我报告确定髋部骨折的发生情况。构建 Cox 比例风险回归模型，允许对预测因子和结果进行重复测量，并使用接收者操作特征曲线（AUC）下的面积和净重新分类改善（NRI）来评估其对股骨颈（FN）和全髋（TH）的 aBMD 的预测能力作为参考。
在中位随访 19.8 年期间，确定了 68 例髋部骨折（2.22/1000 人年）。与 FN-aBMD（AUC=0.701）相比，全髋（AUC=0.741）、股骨颈（AUC=0.748）和转子间（AUC=0.738）的骨小梁容积 BMD（vBMD）的 AUC 显著增大（AUC=0.741），并且有显著的 NRI（分别为 0.177、0.149 和 0.195），但 TH-aBMD 则不然。
使用常规获得的髋部 DXA 图像进行 3D 建模获得的 vBMD 显著提高了髋部骨折风险预测的准确性，而不是 TH-aBMD。
日本基于人群的骨质疏松症（JPOS）队列研究于 2018 年 7 月 1 日在 UMIN 临床研究注册处作为 UMIN000032869 进行了回顾性注册。
