Multiple loading conditions analysis can improve the association between finite element bone strength estimates and proximal femur fractures: A preliminary study in elderly women

Falcinelli, Cristina; Schileo, Enrico; Balistreri, Luca; Baruffaldi, Fabio; Bordini, Barbara; Viceconti, Marco; Albisinni, Ugo; Ceccarelli, Francesco; Milandri, Luigi; Toni, Aldo; Taddei, Fulvia

doi:10.1016/j.bone.2014.06.038

Cited by 82 publications

(82 citation statements)

References 48 publications

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“…The mechanical properties in each element were then calculated from the empirical equations provided by Morgan et al [34,35]: Tensile yield strain was considered equal to 7300 microstrain, and compressive yield strain was considered as 10400 microstrain [13,31]. To account for the side-artefact errors in biomechanical testing of cadaveric trabecular specimen due to the isolation from its original structure, the above material properties were increased by a factor of 1.28 [36].…”

Section: D Dxa Based Finite Element Analysismentioning

confidence: 99%

“…Subject specific finite element (FE) models can estimate the bone strength in simulated loading scenarios by accounting for geometry and BMD distribution. This method has been recently applied to DXA [7][8][9][10][11], to 2D projections from QCT scans [12], and to QCT images [13][14][15][16] in order to estimate the risk of fracture or the effect of anti-osteoporotic drug treatments. Validation studies that compare the FE outcomes to bone strength measurements performed on cadaveric femora have shown that QCT based FE can predict 80-90% of femoral strength in simulated fall [17][18][19][20][21][22] and 80-94% of femoral strength in simulated one legged stance [21,[23][24][25].…”

Section: Introductionmentioning

confidence: 99%

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Experimental validation of DXA-based finite element models for prediction of femoral strength

Dall’Ara

Eastell

Viceconti

et al. 2016

Journal of the Mechanical Behavior of Biomedical Materials

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Osteoporotic fractures are a major clinical problem and current diagnostic tools have an accuracy of only 50%. The aim of this study was to validate dual energy X-rays absorptiometry (DXA)-based finite element (FE) models to predict femoral strength in two loading configurations. Thirty-six pairs of fresh frozen human proximal femora were scanned with DXA and quantitative computed tomography (QCT). For each pair one femur was tested until failure in a one-legged standing configuration (STANCE) and one by replicating the position of the femur in a fall onto the greater trochanter (SIDE). Subject-specific 2D DXA-based linear FE models and 3D QCT-based nonlinear FE models were generated for each specimen and used to predict the measured femoral strength. The outcomes of the models were compared to standard DXA-based areal bone mineral density (aBMD) measurements. For the STANCE configuration the DXA-based FE models (R(2)=0.74, SEE=1473N) outperformed the best densitometric predictor (Neck_aBMD, R(2)=0.66, SEE=1687N) but not the QCT-based FE models (R(2)=0.80, SEE=1314N). For the SIDE configuration both QCT-based FE models (R(2)=0.85, SEE=455N) and DXA neck aBMD (R(2)=0.80, SEE=502N) outperformed DXA-based FE models (R(2)=0.77, SEE=529N). In both configurations the DXA-based FE model provided a good 1:1 agreement with the experimental data (CC=0.87 for SIDE and CC=0.86 for STANCE), with proper optimization of the failure criteria. In conclusion we found that the DXA-based FE models are a good predictor of femoral strength as compared with experimental data ex vivo. However, it remains to be investigated whether this novel approach can provide good predictions of the risk of fracture in vivo.

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Section: D Dxa Based Finite Element Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Experimental validation of DXA-based finite element models for prediction of femoral strength

Dall’Ara

Eastell

Viceconti

et al. 2016

Journal of the Mechanical Behavior of Biomedical Materials

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“…For example in vivo computed tomography data can inform individualised finite element models that accurately predict non-invasively the changes in bone strength or joint stresses in longitudinal studies, both in mice, [37][38][39][40] and in humans. [41][42][43][44][45] This use case is related to refinement, in the definition we provided above, as modelling can replace invasive measurements that involve suffering in animals, and increased risk in humans; or improving the usefulness of the in vivo trials by making measurable a more significant biomarker, while retaining the same level of risk/suffering.…”

Section: In Silico Clinical Trials: Use Cases Current and Futurementioning

confidence: 99%

In silico clinical trials: how computer simulation will transform the biomedical industry

2016

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<p class="abstract">The term ‘in silico clinical trials indicates the use of individualised computer simulation in the development or regulatory evaluation of a medicinal product, medical device, or medical intervention. This review article summarises the research and technological roadmap developed by the Avicenna Support Action during an 18 month consensus process that involved 577 international experts from academia, the biomedical industry, the simulation industry, the regulatory world, etc. The roadmap documents early examples of in silico clinical trials, identifies relevant use cases for in silico clinical trial technologies over the entire development and assessment cycle for both pharmaceuticals and medical devices, identifies open challenges and barriers to a wider adoption and puts forward 36 recommendations for all relevant stakeholders to consider<span lang="EN-US">.</span></p>

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“…to evaluate implant loosening resulting in its failure. Many studies still continue to employ elastic analyses to predict arbitrarily post-elastic behaviour (Falcinelli et al, 2014).…”

mentioning

confidence: 99%

Evaluating the macroscopic yield behaviour of trabecular bone using a nonlinear homogenisation approach

Levrero-Florencio

Margetts

Sales

et al. 2016

Journal of the Mechanical Behavior of Biomedical Materials

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Computational homogenisation approaches using high resolution images and finite element (FE) modelling have been extensively employed to evaluate the anisotropic elastic properties of trabecular bone. The aim of this study was to extend its application to characterise the macroscopic yield behaviour of trabecular bone. Twenty trabecular bone samples were scanned using a micro-computed tomography device, converted to voxelised FE meshes and subjected to 160 load cases each (to define a homogenised multiaxial yield surface which represents several possible strain combinations). Simulations were carried out using a parallel code developed in-house. The nonlinear algorithms included both geometrical and material nonlinearities. The study found that for tension-tension and compression-compression regimes in normal strain space, the yield strains have an isotropic behaviour. However, in the tension-compression quadrants, pure shear and combined normal-shear planes, the macroscopic strain norms at yield have a relatively large variation. Also, our treatment of clockwise and counter-clockwise shears as separate loading cases showed that the differences in these two directions cannot be ignored. A quadric yield surface, used to evaluate the goodness of fit, showed that an isotropic criterion adequately represents yield in strain space though errors with orthotropic and anisotropic criteria are slightly smaller. Consequently, although the isotropic yield surface presents itself as the most suitable assumption, it may not work well for all load cases. This work provides a comprehensive assessment of material symmetries of trabecular bone at the macroscale and describes in detail its macroscopic yield and its underlying microscopic mechanics.

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Multiple loading conditions analysis can improve the association between finite element bone strength estimates and proximal femur fractures: A preliminary study in elderly women

Cited by 82 publications

References 48 publications

Experimental validation of DXA-based finite element models for prediction of femoral strength

Experimental validation of DXA-based finite element models for prediction of femoral strength

In silico clinical trials: how computer simulation will transform the biomedical industry

Evaluating the macroscopic yield behaviour of trabecular bone using a nonlinear homogenisation approach

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