A two-level subject-specific biomechanical model for improving prediction of hip fracture risk

Sarvi, Masoud Nasiri; Luo, Yunhua

doi:10.1016/j.clinbiomech.2015.05.013

Cited by 18 publications

(29 citation statements)

References 60 publications

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“…However, a larger body weight is also associated with a thicker soft tissue over the hip, which is able to attenuate the impact energy and thus reduce the impact force to some extent [161,162]. The resulting impact force is dependent on the dominance of the above two effects [8,113,114]. Body height is also associated with the initial potential energy.…”

Section: Weight and Heightmentioning

confidence: 94%

“…Empirical formulas established from experimental data have been proposed to estimate the impact force using the subject's body weight and height [107,110,115]. However, other parameters also have effects on the impact force, for example, the soft tissue over the hip is able to attenuate the impact energy during sideways fall [109,113]; even the body configuration just Fig. 1 Load-strength ratio, major and sublevel biomechanical variables before touching the ground may change the magnitude of impact force [8,112,116].…”

Section: Biomechanical Variables Determining Hip Fracture Riskmentioning

confidence: 99%

“…1 Load-strength ratio, major and sublevel biomechanical variables before touching the ground may change the magnitude of impact force [8,112,116]. A more accurate way is to determine the impact force by fall simulation using a dynamics model constructed from the subject's whole body medical image [8,111,113,114]. It should be realized that assumptions, for example, the fall type and direction, have been introduced in both fall tests and dynamics simulations, which may be very different from those in a real-world fall.…”

Section: Biomechanical Variables Determining Hip Fracture Riskmentioning

confidence: 99%

“…The effects have been studied by fall tests [14, 17, 107-109] and whole-body dynamics simulations [8,110,[112][113][114]. A greater body weight is associated with a larger initial potential energy if the fall is from standing height.…”

Section: Weight and Heightmentioning

confidence: 99%

“…For assessment purpose, the impact force can be estimated from fall test [14, 17, [106][107][108][109][110] or determined by fall dynamics simulation [8,[111][112][113][114]. Empirical formulas established from experimental data have been proposed to estimate the impact force using the subject's body weight and height [107,110,115].…”

Section: Biomechanical Variables Determining Hip Fracture Riskmentioning

confidence: 99%

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A biomechanical sorting of clinical risk factors affecting osteoporotic hip fracture

Luo

2015

Osteoporos Int

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Osteoporotic fracture has been found associated with many clinical risk factors, and the associations have been explored dominantly by evidence-based and case-control approaches. The major challenges emerging from the studies are the large number of the risk factors, the difficulty in quantification, the incomplete list, and the interdependence of the risk factors. A biomechanical sorting of the risk factors may shed lights on resolving the above issues. Based on the definition of load-strength ratio (LSR), we first identified the four biomechanical variables determining fracture risk, i.e., the risk of fall, impact force, bone quality, and bone geometry. Then, we explored the links between the FRAX clinical risk factors and the biomechanical variables by looking for evidences in the literature. To accurately assess fracture risk, none of the four biomechanical variables can be ignored and their values must be subject-specific. A clinical risk factor contributes to osteoporotic fracture by affecting one or more of the biomechanical variables. A biomechanical variable represents the integral effect from all the clinical risk factors linked to the variable. The clinical risk factors in FRAX mostly stand for bone quality. The other three biomechanical variables are not adequately represented by the clinical risk factors. From the biomechanical viewpoint, most clinical risk factors are interdependent to each other as they affect the same biomechanical variable(s). As biomechanical variables must be expressed in numbers before their use in calculating LSR, the numerical value of a biomechanical variable can be used as a gauge of the linked clinical risk factors to measure their integral effect on fracture risk, which may be more efficient than to study each individual risk factor.

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Section: Weight and Heightmentioning

confidence: 94%

Section: Biomechanical Variables Determining Hip Fracture Riskmentioning

confidence: 99%

Section: Biomechanical Variables Determining Hip Fracture Riskmentioning

confidence: 99%

Section: Weight and Heightmentioning

confidence: 99%

Section: Biomechanical Variables Determining Hip Fracture Riskmentioning

confidence: 99%

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A biomechanical sorting of clinical risk factors affecting osteoporotic hip fracture

Luo

2015

Osteoporos Int

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Sideways fall-induced impact force and its effect on hip fracture risk: a review

Sarvi

Luo

2017

Osteoporos Int

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The analysis of the gathered data revealed that there is a need to develop modified biomechanical models for more accurate prediction of the impact force and appropriately adopt them in hip fracture risk assessment tools in order to achieve a better precision in identifying high-risk patients. Graphical abstract Impact force to the hip induced in sideways falls is affected by many parameters and may remarkably vary from subject to subject.

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Fatal falls in the elderly and the presence of proximal femur fractures

et al. 2018

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Fatal falls are frequent and seem to be an increasing problem in the elderly. Especially ground level falls (GLFs) and falls on or from stairs and steps (stairs falls) are worth examining for forensic classification and in order to improve the development of preventive measures. We retrospectively analyzed 261 fatal falls of elderly age 65 + years, which were autopsied at the Institute of Legal Medicine in Munich between 2008 and 2014. After careful screening, the sub-set of all 77 GLFs and 39 stairs falls were analyzed towards socio-demographic characteristics, fall circumstances, injuries, and circumstances of death. A subsequent analysis of GLF cases regarding the presence of proximal femur fractures (PFF) was performed. The injury pattern of the GLFs and the stairs falls clearly differ with a higher share of injuries to the lower extremities in the GLFs. However, the most severely injured body region was the head in both groups (62% of the stairs cases, 49% of the GLF cases). Alcohol as contributing to the fall was seen more frequently in the stairs falls. PFF were not seen in the stairs falls, but then in 18 GLF cases. Yet, for 17 among them (22% of 77), their hip fracture was the only serious injury leading to hospitalization and death. Only one GLF case was already found dead. This finding indicates a potential of avoiding up to 22% of the GLF fatalities by preventing hip fractures by optimized hip protectors or other measures, especially for the elderly aged 75 + years.

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A two-level subject-specific biomechanical model for improving prediction of hip fracture risk

Cited by 18 publications

References 60 publications

A biomechanical sorting of clinical risk factors affecting osteoporotic hip fracture

A biomechanical sorting of clinical risk factors affecting osteoporotic hip fracture

Sideways fall-induced impact force and its effect on hip fracture risk: a review

Fatal falls in the elderly and the presence of proximal femur fractures

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