Geometry of proximal femur in the prediction of hip fracture in osteoporotic women.

Gnudi, S; Ripamonti, C; Gualtieri, G; Malavolta, N

doi:10.1259/bjr.72.860.10624337

Cited by 131 publications

(111 citation statements)

References 32 publications

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“…Nevertheless, it should be pointed out that in males, a statistically significant inverse relationship between the NSA and FN-BMD was found, as already reported by others, 14,18 which was not observed in females. 26,29 The latter finding was also reported by other authors, 9,30 who found NSA to be an independent predictor of hip fracture in females. Therefore, it may be that the negative correlation of FN-BMD with NSA leads BMD to capture some of the effects of NSA on hip fracture; thus explaining, at least partially, the disagreement between males and females regarding the independence of the ability of NSA to predict hip fracture.…”

Section: Discussionsupporting

confidence: 80%

“…This agrees with reports by some authors 16,18 but is in contrast to the findings of Alonso et al 14 and the majority of reports in the literature about NSA hip fracture prediction in females. 10,11,14,22,26 Concerning the independence of the ability of NSA to predict hip fracture, the contrasting results between previous studies in females 10,29 and the present one in males might be a result of a statistical weakness of the present study because of the low number of fractures in males. Nevertheless, it should be pointed out that in males, a statistically significant inverse relationship between the NSA and FN-BMD was found, as already reported by others, 14,18 which was not observed in females.…”

Section: Discussioncontrasting

confidence: 66%

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Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density

Ripamonti¹,

Lisi²,

Avella³

2014

The British Journal of Radiology

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Objective: To investigate the specificity of the neck shaft angle (NSA) to predict hip fracture in males. Methods: We consecutively studied 228 males without fracture and 38 with hip fracture. A further 49 males with spine fracture were studied to evaluate the specificity of NSA for hip-fracture prediction. Femoral neck (FN) bone mineral density (FN-BMD), NSA, hip axis length and FN diameter (FND) were measured in each subject by dual X-ray absorptiometry. Between-mean differences in the studied variables were tested by the unpaired t-test. The ability of NSA to predict hip fracture was tested by logistic regression. Results: Compared with controls, FN-BMD (p < 0.01) was significantly lower in both groups of males with fractures, whereas FND (p < 0.01) and NSA (p = 0.05) were higher only in the hip-fracture group. A significant inverse correlation (p < 0.01) was found between NSA and FN-BMD. By age-, height- and weight-corrected logistic regression, none of the tested geometric parameters, separately considered from FN-BMD, entered the best model to predict spine fracture, whereas NSA (p < 0.03) predicted hip fracture together with age (p < 0.001). When forced into the regression, FN-BMD (p < 0.001) became the only fracture predictor to enter the best model to predict both fracture types. Conclusion: NSA is associated with hip-fracture risk in males but is not independent of FN-BMD. Advances in knowledge: The lack of ability of NSA to predict hip fracture in males independent of FN-BMD should depend on its inverse correlation with FN-BMD by capturing, as the strongest fracture predictor, some of the effects of NSA on the hip fracture. Conversely, NSA in females does not correlate with FN-BMD but independently predicts hip fractures.

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Section: Discussionsupporting

confidence: 80%

Section: Discussioncontrasting

confidence: 66%

Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density

Ripamonti¹,

Lisi²,

Avella³

2014

The British Journal of Radiology

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“…Recent data suggest that weakened cortical bone may primarily be responsible for hip intracapsular hip fracture (6), thus emphasizing the importance for quantitatively assessing and monitoring cortical structure. Support for the role of cortical bone architecture as a risk factor for hip fracture is found in several studies of postmenpausal osteoporosis, where strong associations have been reported between proximal femur geometry and fracture incidence (7)(8)(9). Additionally, bone mineral density (BMD) supplemented by femoral geometry has been shown to be more predictive of breaking strength than BMD alone (10).…”

Section: Introductionmentioning

confidence: 99%

Method for Cortical Bone Structural Analysis From Magnetic Resonance Images1

Gomberg¹,

Saha²,

Wehrli³

2005

Academic Radiology

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Rationale-Quantitative evaluation of cortical bone architecture as a means to assess bone strength is typically accomplished on the basis of images obtained by dual-energy X-ray absorptiometry (DXA) or computed tomography (CT). Magnetic resonance imaging (MRI) has potential advantages for this task in that it allows imaging in arbitrary scan planes at high spatial resolution. However, several hurdles have to be overcome in order to make this approach practical, including resolution of issues related to nonlinear receive coil sensitivity, variations in marrow composition and the presence periosteal isointense tissues which all complicate segmentation. Objectives-To develop MR acquisition and analysis methods optimized for detection of cortical boundaries in complex geometries such as the femoral neck.Materials and Methods-Cortical boundary detection is achieved by radially tracing intensity profiles that intersect the bone's periosteal and endosteal boundary. The profiles are subsequently normalized to the intensity of the marrow signal, processed with morphologic image operators and binarized. The resulting boundaries are then mapped back onto the spatial image and erroneous boundary points removed. From the detected cortical boundaries cortical cross-sectional area and thickness are computed. The method was evaluated on cortical bone specimens and human volunteers on the basis of high-resolution images acquired at 1.5 Tesla field strength. To assess whether the method is sensitive to detect the expected dependencies of cortical parameters in weight-bearing bone on overall habitus, ten women ages 46-73 years (mean 56 years) underwent the cortical imaging protocol in the proximal femur and the results were compared with DXA BMD parameters of the hip and spine.Results-Reproducibility was on the order of 2%. Double oblique images of the femoral neck in the ten women studied showed cortical cross-sectional area to correlate strongly with height (r = 0.88, p = 0.0008) while cortical diameter versus age approached significance (r = 0.61, p = 0.06). Measurements in specimens of some cortical parameters indicated a resolution dependence. It is to be noted, however, that parameter rank remained constant across all specimens studied. Conclusion-The data suggest the new method to be robust and applicable on standard clinical MR scanners at arbitrary anatomic locations to yield clinically meaningful quantitative results.

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“…However, the two density distributions, of patients at-risk and age-matched controls, have been found to overlap by large amounts, reducing the accuracy of classification to about 65% [2]. It has been shown that, in addition to BMD, other structural parameters, such as bone architecture and bone geometry, also play a nonnegligible role in determining bone competence [3][4][5][6][7][8].…”

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confidence: 99%

Differential Effects of Bone Structural and Material Properties on Bone Competence in C57BL/6 and C3H/He Inbred Strains of Mice

2008

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The femoral neck is a relevant and sensitive site for studying the degree of osteopenia. Engineering principles predict that bone structural parameters, like cross-sectional geometry, are important determinants of bone mechanical parameters. Mechanical parameters are also directly affected by the material properties of the bone tissue. However, the relative importance of structural and material properties is still unknown. The aim of this study was to compare bone competence and structural parameters between a murine strain showing a low bone mass phenotype, C57BL/6 (B6), and another one showing a high bone mass phenotype, C3H/He (C3H), in order to better determine the role of bone structure and geometry in bone failure behavior. Murine femora of 12-and 16-week-old B6 and 12-and 16-week-old C3H inbred strains were mechanically tested under axial loading of the femoral head. In order to assess the structural properties, we performed three-dimensional morphometric analyses in five different compartments of the mouse femur using micro-computed tomography. The mechanical tests revealed that B6 femora became stiffer, stronger, and tougher at 12-16 weeks, while bone brittleness stayed constant. C3H bone stiffness increased, but strength remained constant, work to failure decreased, and bone became more brittle. These age effects indicated that B6 did not reach peak bone properties at 16 weeks of age and C3H did reach maximal skeletal biomechanical properties before 16 weeks of age. Our investigations showed that 83% of the strength of the femoral neck in the B6 strain was explained by cortical thickness at this location; in contrast, in C3H none of the mechanical properties of the femoral neck was explained by bone structural parameters. The relative contributions of bone structural and material properties on bone strength are different in B6 and C3H. We hypothesize that these different contributions are related to differences at the ultrastructural level of bone that affect bone failure.

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Geometry of proximal femur in the prediction of hip fracture in osteoporotic women.

Cited by 131 publications

References 32 publications

Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density

Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density

Method for Cortical Bone Structural Analysis From Magnetic Resonance Images1

Differential Effects of Bone Structural and Material Properties on Bone Competence in C57BL/6 and C3H/He Inbred Strains of Mice

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