Finite Element Assessment of Bone Fragility from Clinical Images

Schileo, Enrico; Taddei, Fulvia

doi:10.1007/s11914-021-00714-7

Cited by 13 publications

(8 citation statements)

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“…We adopted diagnostic categories based on spine QCTtrabecular vBMD measurements as the gold standard since previous FEA studies verified the equivalence of FEA and vBMD osteoporotic fracture predictivity, which is superior to DXA (8,9). Compared to QCT, the FE method takes bone geometry and the contribution of cortical bone to bone strength into consideration and requires no additional imaging hardware and radiation exposure (7).…”

Section: Discussionmentioning

confidence: 99%

“…The FE method has been used to simulate the mechanical behavior of bone with increasing fidelity for decades, which has shown great reliability to assess bone strength and fracture risk (8)(9)(10). Previous studies confirmed the superiority of FEA to DXA-aBMD (11) and even QCT-vBMD (12) in both prevalent and incident vertebral fracture prediction (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

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Influence of image reconstruction kernel on computed tomography-based finite element analysis in the clinical opportunistic screening of osteoporosis—A preliminary result

Jiang

Jin²,

Ming³

et al. 2023

Front. Endocrinol.

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PurposeThis study aimed to evaluate the difference in vertebral mechanical properties estimated by finite element analysis (FEA) with different computed tomography (CT) reconstruction kernels and evaluate their accuracy in the screening and classification of osteoporosis.MethodsThere were 31 patients enrolled retrospectively from the quantitative CT database of our hospital, uniformly covering the range from osteoporosis to normal. All subjects’ CT raw data were reconstructed both with a smooth standard convolution kernel (B40f) and a sharpening bone convolution kernel (B70f), and FEA was performed on L1 of each subject based on two reconstructed images to obtain vertebral estimated strength and stiffness. The trabecular volumetric bone mineral density (vBMD) of the same vertebral body was also measured. FEA measurements between two kernels and their accuracy for osteoporosis screening were compared.ResultsThe vertebral stiffness and strength measured in FEA-B40f were significantly lower compared with those of FEA-B70f (12.0%, p = 0.000 and 10.7%, p = 0.000, respectively). The correlation coefficient between FEA-B70F and vBMD was slightly higher than that of FEA-B40F in both vertebral strength and stiffness (strength: r2-B40f = 0.21, p = 0.009 vs. r2-B70f = 0.27, p = 0.003; stiffness: r2-B40f = 0.37, p = 0.002 vs. r2-B70f = 0.45, p=0.000). The receiver operator characteristic curve showed little difference in the classification of osteoporosis between FEA-B40f and FEA-B70f.ConclusionTwo kernels both seemed to be applicable to the opportunistic screening of osteoporosis by CT-FEA despite variance in FE-estimated bone strength and bone stiffness. A protocol for CT acquisition and FEA is still required to guarantee the reproducibility of clinical use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of image reconstruction kernel on computed tomography-based finite element analysis in the clinical opportunistic screening of osteoporosis—A preliminary result

Jiang

Jin²,

Ming³

et al. 2023

Front. Endocrinol.

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“…(14)(15)(16) Subject-specific finite element (FE) models have been proposed as a tool to improve hip fracture risk assessment by providing an accurate estimate of the individual bone strength. (17,18) There is ample evidence that subject-specific FE models can predict proximal femoral strength better than aBMD in ex vivo experimental conditions. (19)(20)(21) Despite that, subject-specific FE models struggle to be implemented into the daily clinical practice to predict incident hip fractures.…”

Section: Introductionmentioning

confidence: 99%

“…This is partly because this superior ability to predict proximal femoral strength has not been conclusively translated into a significant improvement in the sensitivity and specificity of hip fracture risk assessment in clinical cohorts when compared to aBMD. (18,22) Additionally, subject-specific FE models often come with additional hinders in terms of increased cost, time, and lack of automation, which may make their clinical adoption less cost-effective despite an increased prediction accuracy compared to aBMD. (22,23) Many studies using FE-derived strength to predict risk for fracture did not report a statistically significant improvement in hip fracture cases prediction when compared to aBMD.…”

Section: Introductionmentioning

confidence: 99%

“…(26) Recently, some studies reported relevant improvements in fracture risk assessment when using subject-specific FE models. (18,24) In particular, two studies conducted on a randomly selected subcohort from the AGES Reykjavik Study and using advanced biofidelic FE models of a fall to the side, reported some promising outcome. Enns-Bray and colleagues (27) did not improve the identification of incident hip fractures compared to aBMD on 254 female patients, but reported that FE models performed better than aBMD when patients who did not fall were excluded from the analysis, which can be seen as a way to exclude the covariate of risk of falling.…”

Section: Introductionmentioning

confidence: 99%

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3D Finite Element Models Reconstructed From 2D Dual‐Energy X‐Ray Absorptiometry (DXA) Images Improve Hip Fracture Prediction Compared to Areal BMD in Osteoporotic Fractures in Men (MrOS) Sweden Cohort

Grassi

Väänänen

Jehpsson

et al. 2023

J of Bone & Mineral Res

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Bone strength is an important contributor to fracture risk. Areal bone mineral density (aBMD) derived from dual‐energy X‐ray absorptiometry (DXA) is used as a surrogate for bone strength in fracture risk prediction tools. 3D finite element (FE) models predict bone strength better than aBMD, but their clinical use is limited by the need for 3D computed tomography and lack of automation. We have earlier developed a method to reconstruct the 3D hip anatomy from a 2D DXA image, followed by subject‐specific FE‐based prediction of proximal femoral strength. In the current study, we aim to evaluate the method's ability to predict incident hip fractures in a population‐based cohort (Osteoporotic Fractures in Men [MrOS] Sweden). We defined two subcohorts: (i) hip fracture cases and controls cohort: 120 men with a hip fracture (<10 years from baseline) and two controls to each hip fracture case, matched by age, height, and body mass index; and (ii) fallers cohort: 86 men who had fallen the year before their hip DXA scan was acquired, 15 of which sustained a hip fracture during the following 10 years. For each participant, we reconstructed the 3D hip anatomy and predicted proximal femoral strength in 10 sideways fall configurations using FE analysis. The FE‐predicted proximal femoral strength was a better predictor of incident hip fractures than aBMD for both hip fracture cases and controls (difference in area under the receiver operating characteristics curve, ΔAUROC = 0.06) and fallers (ΔAUROC = 0.22) cohorts. This is the first time that FE models outperformed aBMD in predicting incident hip fractures in a population‐based prospectively followed cohort based on 3D FE models obtained from a 2D DXA scan. Our approach has potential to notably improve the accuracy of fracture risk predictions in a clinically feasible manner (only one single DXA image is needed) and without additional costs compared to the current clinical approach. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Comparison of Two Models to Predict Vertebral Failure Loads on the Same Experimental Dataset

Allard,

Heidsieck,

Bermond

et al. 2024

Lecture Notes in Computational Vision and Biomechanics

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Finite Element Assessment of Bone Fragility from Clinical Images

Cited by 13 publications

References 86 publications

Influence of image reconstruction kernel on computed tomography-based finite element analysis in the clinical opportunistic screening of osteoporosis—A preliminary result

Influence of image reconstruction kernel on computed tomography-based finite element analysis in the clinical opportunistic screening of osteoporosis—A preliminary result

3D Finite Element Models Reconstructed From 2D Dual‐Energy X‐Ray Absorptiometry (DXA) Images Improve Hip Fracture Prediction Compared to Areal BMD in Osteoporotic Fractures in Men (MrOS) Sweden Cohort

Comparison of Two Models to Predict Vertebral Failure Loads on the Same Experimental Dataset

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