Effect of finite element model loading condition on fracture risk assessment in men and women: The AGES-Reykjavik study
Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the associati...
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| Published in | Bone (New York, N.Y.) Vol. 57; no. 1; pp. 18 - 29 |
|---|---|
| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Amsterdam
Elsevier Inc
01.11.2013
Elsevier |
| Subjects | |
| Online Access | Get full text |
| ISSN | 8756-3282 1873-2763 1873-2763 |
| DOI | 10.1016/j.bone.2013.07.028 |
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| Abstract | Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case–control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4–7years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls from a pool of age- and sex-matched subjects. From the QCT data, FE models employing nonlinear material properties computed FE-strength of the left hip of each subject in loading from a fall onto the posterolateral (FPL), posterior (FP) and lateral (FL) aspects of the greater trochanter (patent pending). For comparison, FE strength in stance loading (FStance) and total femur areal bone mineral density (aBMD) were also computed. For all loading conditions, the reductions in strength associated with fracture in men were more than twice those in women (p≤0.01). For fall loading specifically, posterolateral loading in men and posterior loading in women were most strongly associated with incident hip fracture. After adjusting for aBMD, the association between FP and fracture in women fell short of statistical significance (p=0.08), indicating that FE strength provides little advantage over aBMD for identifying female hip fracture subjects. However, in men, after controlling for aBMD, FPL was 424N (11%) less in subjects with fractures than in controls (p=0.003). Thus, in men, FE models of posterolateral loading include information about incident hip fracture beyond that in aBMD.
•We performed a prospective study of hip fracture in a group of older men and women.•Finite element-computed hip strength in fracture and control subjects was obtained.•Stance and posterolateral, posterior and lateral fall loading were analyzed.•Posterolateral and posterior loading in men and women, respectively, were most strongly associated with hip fracture. |
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| AbstractList | Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4-7years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls from a pool of age- and sex-matched subjects. From the QCT data, FE models employing nonlinear material properties computed FE-strength of the left hip of each subject in loading from a fall onto the posterolateral (FPL), posterior (FP) and lateral (FL) aspects of the greater trochanter (patent pending). For comparison, FE strength in stance loading (FStance) and total femur areal bone mineral density (aBMD) were also computed. For all loading conditions, the reductions in strength associated with fracture in men were more than twice those in women (p≤0.01). For fall loading specifically, posterolateral loading in men and posterior loading in women were most strongly associated with incident hip fracture. After adjusting for aBMD, the association between FP and fracture in women fell short of statistical significance (p=0.08), indicating that FE strength provides little advantage over aBMD for identifying female hip fracture subjects. However, in men, after controlling for aBMD, FPL was 424N (11%) less in subjects with fractures than in controls (p=0.003). Thus, in men, FE models of posterolateral loading include information about incident hip fracture beyond that in aBMD. Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4-7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls from a pool of age- and sex-matched subjects. From the QCT data, FE models employing nonlinear material properties computed FE-strength of the left hip of each subject in loading from a fall onto the posterolateral (FPL), posterior (FP) and lateral (FL) aspects of the greater trochanter. For comparison, FE strength in stance loading (FStance) and total femur areal bone mineral density (aBMD) were also computed. For all loading conditions, the reductions in strength associated with fracture in men were more than twice those in women (p≤0.01). For fall loading specifically, posterolateral loading in men and posterior loading in women were most strongly associated with incident hip fracture. After adjusting for aBMD, the association between FP and fracture in women fell short of statistical significance (p=0.08), indicating that FE strength provides little advantage over aBMD for identifying female hip fracture subjects. However, in men, after controlling for aBMD, FPL was 424 N (11%) less in subjects with fractures than in controls (p=0.003). Thus, in men, FE models of posterolateral loading include information about incident hip fracture beyond that in aBMD. Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4-7years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls from a pool of age- and sex-matched subjects. From the QCT data, FE models employing nonlinear material properties computed FE-strength of the left hip of each subject in loading from a fall onto the posterolateral (FPL), posterior (FP) and lateral (FL) aspects of the greater trochanter (patent pending). For comparison, FE strength in stance loading (FStance) and total femur areal bone mineral density (aBMD) were also computed. For all loading conditions, the reductions in strength associated with fracture in men were more than twice those in women (p≤0.01). For fall loading specifically, posterolateral loading in men and posterior loading in women were most strongly associated with incident hip fracture. After adjusting for aBMD, the association between FP and fracture in women fell short of statistical significance (p=0.08), indicating that FE strength provides little advantage over aBMD for identifying female hip fracture subjects. However, in men, after controlling for aBMD, FPL was 424N (11%) less in subjects with fractures than in controls (p=0.003). Thus, in men, FE models of posterolateral loading include information about incident hip fracture beyond that in aBMD.Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4-7years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls from a pool of age- and sex-matched subjects. From the QCT data, FE models employing nonlinear material properties computed FE-strength of the left hip of each subject in loading from a fall onto the posterolateral (FPL), posterior (FP) and lateral (FL) aspects of the greater trochanter (patent pending). For comparison, FE strength in stance loading (FStance) and total femur areal bone mineral density (aBMD) were also computed. For all loading conditions, the reductions in strength associated with fracture in men were more than twice those in women (p≤0.01). For fall loading specifically, posterolateral loading in men and posterior loading in women were most strongly associated with incident hip fracture. After adjusting for aBMD, the association between FP and fracture in women fell short of statistical significance (p=0.08), indicating that FE strength provides little advantage over aBMD for identifying female hip fracture subjects. However, in men, after controlling for aBMD, FPL was 424N (11%) less in subjects with fractures than in controls (p=0.003). Thus, in men, FE models of posterolateral loading include information about incident hip fracture beyond that in aBMD. Abstract Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case–control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4–7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls from a pool of age- and sex-matched subjects. From the QCT data, FE models employing nonlinear material properties computed FE-strength of the left hip of each subject in loading from a fall onto the posterolateral (FPL ), posterior (FP ) and lateral (FL ) aspects of the greater trochanter (patent pending). For comparison, FE strength in stance loading (FStance ) and total femur areal bone mineral density (aBMD) were also computed. For all loading conditions, the reductions in strength associated with fracture in men were more than twice those in women (p ≤ 0.01). For fall loading specifically, posterolateral loading in men and posterior loading in women were most strongly associated with incident hip fracture. After adjusting for aBMD, the association between FP and fracture in women fell short of statistical significance (p = 0.08), indicating that FE strength provides little advantage over aBMD for identifying female hip fracture subjects. However, in men, after controlling for aBMD, FPL was 424 N (11%) less in subjects with fractures than in controls (p = 0.003). Thus, in men, FE models of posterolateral loading include information about incident hip fracture beyond that in aBMD. Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case–control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4–7years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls from a pool of age- and sex-matched subjects. From the QCT data, FE models employing nonlinear material properties computed FE-strength of the left hip of each subject in loading from a fall onto the posterolateral (FPL), posterior (FP) and lateral (FL) aspects of the greater trochanter (patent pending). For comparison, FE strength in stance loading (FStance) and total femur areal bone mineral density (aBMD) were also computed. For all loading conditions, the reductions in strength associated with fracture in men were more than twice those in women (p≤0.01). For fall loading specifically, posterolateral loading in men and posterior loading in women were most strongly associated with incident hip fracture. After adjusting for aBMD, the association between FP and fracture in women fell short of statistical significance (p=0.08), indicating that FE strength provides little advantage over aBMD for identifying female hip fracture subjects. However, in men, after controlling for aBMD, FPL was 424N (11%) less in subjects with fractures than in controls (p=0.003). Thus, in men, FE models of posterolateral loading include information about incident hip fracture beyond that in aBMD. •We performed a prospective study of hip fracture in a group of older men and women.•Finite element-computed hip strength in fracture and control subjects was obtained.•Stance and posterolateral, posterior and lateral fall loading were analyzed.•Posterolateral and posterior loading in men and women, respectively, were most strongly associated with hip fracture. Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying subjects at risk of hip fracture. However, to our knowledge, no published study has reported the effect of loading condition on the association between incident hip fracture and hip strength. In the present study, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort Baseline (pre-fracture) quantitative CT (QCT) scans of 5500 older male and female subjects were obtained. During 4-7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as controls from a pool of age- and sex-matched subjects. From the QCT data, FE models employing nonlinear material properties computed FE-strength of the left hip of each subject in loading from a fall onto the posterolateral (F-PL), posterior (F-P) and lateral (F-L) aspects of the greater trochanter (patent pending). For comparison, FE strength in stance loading (F-Stance) and total femur areal bone mineral density (aBMD) were also computed. For all loading conditions, the reductions in strength associated with fracture in men were more than twice those in women (p <= 0.01). For fall loading specifically, posterolateral loading in men and posterior loading in women were most strongly associated with incident hip fracture. After adjusting for aBMD, the association between F-P and fracture in women fell short of statistical significance (p = 0.08), indicating that FE strength provides little advantage over aBMD for identifying female hip fracture subjects. However, in men, after controlling for aBMD, F-PL was 424 N (11%) less in subjects with fractures than in controls (p = 0.003). Thus, in men, FE models of posterolateral loading include information about incident hip fracture beyond that in aBMD. (c) 2013 Elsevier Inc. All rights reserved. |
| Author | Kornak, J. Sigmarsdottir, A. Siggeirsdottir, K. Sigurdsson, G. Oskarsdottir, D. Harris, T.B. Jonsson, B.Y. Sigurdsson, S. Karlsdottir, G.S. Gudnason, V. Lang, T.F. Keyak, J.H. Eiriksdottir, G. |
| AuthorAffiliation | e University of Iceland, Reykjavik, Iceland i Landspitalinn University Hospital, Reykjavik, Iceland a Department of Radiological Sciences, University of California, Irvine, CA, USA d Icelandic Heart Association Research Institute, Kópavogur, Iceland j Department of Orthopaedics, Skane University Hospital, Malmo, Sweden c Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA f Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA b Department of Biomedical Engineering, University of California, Irvine, CA, USA h Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA g Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA |
| AuthorAffiliation_xml | – name: d Icelandic Heart Association Research Institute, Kópavogur, Iceland – name: j Department of Orthopaedics, Skane University Hospital, Malmo, Sweden – name: g Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA – name: e University of Iceland, Reykjavik, Iceland – name: f Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA – name: c Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA – name: a Department of Radiological Sciences, University of California, Irvine, CA, USA – name: h Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA – name: b Department of Biomedical Engineering, University of California, Irvine, CA, USA – name: i Landspitalinn University Hospital, Reykjavik, Iceland |
| Author_xml | – sequence: 1 givenname: J.H. surname: Keyak fullname: Keyak, J.H. email: jhkeyak@uci.edu organization: Department of Radiological Sciences, University of California, Irvine, CA, USA – sequence: 2 givenname: S. surname: Sigurdsson fullname: Sigurdsson, S. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 3 givenname: G.S. surname: Karlsdottir fullname: Karlsdottir, G.S. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 4 givenname: D. surname: Oskarsdottir fullname: Oskarsdottir, D. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 5 givenname: A. surname: Sigmarsdottir fullname: Sigmarsdottir, A. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 6 givenname: J. surname: Kornak fullname: Kornak, J. organization: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA – sequence: 7 givenname: T.B. surname: Harris fullname: Harris, T.B. organization: Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA – sequence: 8 givenname: G. surname: Sigurdsson fullname: Sigurdsson, G. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 9 givenname: B.Y. surname: Jonsson fullname: Jonsson, B.Y. organization: Department of Orthopedics, Skane University Hospital, Malmo, Sweden – sequence: 10 givenname: K. surname: Siggeirsdottir fullname: Siggeirsdottir, K. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 11 givenname: G. surname: Eiriksdottir fullname: Eiriksdottir, G. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 12 givenname: V. surname: Gudnason fullname: Gudnason, V. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 13 givenname: T.F. surname: Lang fullname: Lang, T.F. organization: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA |
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| ContentType | Journal Article |
| Copyright | 2013 Elsevier Inc. Elsevier Inc. 2014 INIST-CNRS 2013. 2013 Elsevier Inc. All rights reserved. 2013 |
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| CorporateAuthor | Department of Clinical Sciences, Lund Faculty of Medicine Institutionen för kliniska vetenskaper, Lund Lunds universitet Section III Medicinska fakulteten Lund University Sektion III Orthopaedics (Lund) Ortopedi, Lund |
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| Keywords | Femur FPL FL FP L FStance P Osteoporosis Hip fracture Quantitative computed tomography Finite element analysis PL Bone strength FE finite element analysis-computed proximal femoral strength for loading representing a fall onto the posterolateral aspect of the greater trochanter posterolateral finite element F Stance posterior lateral finite element analysis-computed proximal femoral strength for loading similar to that during single-limb stance F L F PL F P finite element analysis-computed proximal femoral strength for loading representing a fall onto the lateral aspect of the greater trochanter finite element analysis-computed proximal femoral strength for loading representing a fall onto the posterior aspect of the greater trochanter Human Radiodiagnosis Diseases of the osteoarticular system Fracture Trauma Hip Morphology Risk factor Medical imagery Models Computerized axial tomography Bone Woman Age Strength Quantitative analysis Finite element F(PL) F(Stance) F(P) F(L) |
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| Snippet | Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for identifying... Abstract Proximal femoral (hip) strength computed by subject-specific CT scan-based finite element (FE) models has been explored as an improved measure for... |
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| SubjectTerms | Aged Aged, 80 and over Biological and medical sciences Bone strength Clinical Medicine Diseases of the osteoarticular system Female Femur Finite Element Analysis Fractures, Bone - diagnostic imaging Fundamental and applied biological sciences. Psychology Hip fracture Hip Fractures - diagnostic imaging Humans Injuries of the limb. Injuries of the spine Klinisk medicin Male Medical and Health Sciences Medical sciences Medicin och hälsovetenskap Orthopaedics Orthopedics Ortopedi Osteoporosis Osteoporosis - diagnostic imaging Osteoporosis. Osteomalacia. Paget disease Prospective Studies Quantitative computed tomography Radiography Traumas. Diseases due to physical agents Vertebrates: anatomy and physiology, studies on body, several organs or systems |
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| Title | Effect of finite element model loading condition on fracture risk assessment in men and women: The AGES-Reykjavik study |
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