Study of sex differences in the association between hip fracture risk and body parameters by DXA-based biomechanical modeling

Nasiri, Masoud; Luo, Yunhua

doi:10.1016/j.bone.2016.06.006

Cited by 27 publications

(16 citation statements)

References 93 publications

(155 reference statements)

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“…[ 8 – 10 ] An alternative metric for femur is quantitative computed tomography (CT) based finite element analysis (FEA). [ 11 – 13 ] Although this metric performs better than aBMD against cadaveric femoral strength measures, in cohort studies, FEA-based femoral strength prediction demonstrated only marginal improvement over aBMD-based risk assessment, [ 14 – 23 ] suggesting that both metrics may not account for all relevant biomechanical factors. Another important aspect affecting the risk of hip fracture is the load experienced by the femur due to a fall.…”

Section: Introductionmentioning

confidence: 99%

A novel sideways fall simulator to study hip fractures ex vivo

et al. 2018

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Falls to the side are the leading cause of hip fractures in the elderly. The load that a person experiences during a fall cannot be measured with volunteers for ethical reasons. To evaluate injurious loads, while considering relevant energy input and body posture for a sideways fall, a subject-specific cadaveric impact experiment was developed. Full cadaveric femur-pelvis constructs (N = 2) were embedded in surrogate soft tissue material and attached to metallic surrogate lower limbs. The specimens were then subjected to an inverted pendulum motion, simulating a fall to the side with an impact to the greater trochanter. The load at the ground and the deformation of the pelvis were evaluated using a 6-axis force transducer and two high-speed cameras. Post-test, a trauma surgeon (PG) evaluated specimen injuries. Peak ground contact forces were 7132 N and 5641 N for the fractured and non-fractured specimen, respectively. We observed a cervical fracture of the femur in one specimen and no injuries in a second specimen, showing that the developed protocol can be used to differentiate between specimens at high and low fracture risk.

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Section: Introductionmentioning

confidence: 99%

A novel sideways fall simulator to study hip fractures ex vivo

et al. 2018

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“…32 A potential weakness of using DXA/aBMD without accounting for sex in fracture risk assessment was evident in a recent study involving mechanical testing of 100 cadaveric femurs, which found that for a given DXA/aBMD value, women’s proximal femurs had lower fracture strengths than men’s proximal femurs. 27 Other studies concluded that DXA/aBMD is a better predictor of hip fracture in men than in women, 7, 26 indicating that sex may be an important factor. With respect to the ability of DXA/aBMD to account for changes related to age, a recent study found that femoral strength decreased with age faster than did DXA/aBMD.…”

Section: Introductionmentioning

confidence: 99%

Are DXA/aBMD and QCT/FEA Stiffness and Strength Estimates Sensitive to Sex and Age?

et al. 2017

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Dual X-ray absorptiometry (DXA) measures areal bone mineral density (aBMD) by simplifying a complex 3D bone structure to a 2D projection and is not equally effective for explaining fracture strength in women and men. Unlike DXA, subject-specific quantitative computed tomography-based finite element analysis (QCT/FEA) estimates fracture strength using 3D bone mineral distribution and geometry. By using experimentally-measured femoral stiffness and strength from a one hundred sample cadaveric cohort that included variations in sex and age, we wanted to determine if QCT/FEA estimates were able to better predict the experimental variations than DXA/aBMD. For each femur, DXA/aBMD was assessed and a QCT/FEA model was developed to estimate femoral stiffness and strength. Then, the femur was mechanically tested to fracture in a sideways fall on the hip position to measure stiffness and strength. DXA/aBMD and QCT/FEA estimates were compared for their sensitivity to sex and age with multivariate statistical analyses. When comparing the measured data with DXA/aBMD predictions, both age and sex were significant (P≤0.0398) for both femoral stiffness and strength. However, QCT/FEA predictions of stiffness and strength showed sex was insignificant (P≥0.23). Age was still significant (P≤0.0072). These results indicate that QCT/FEA, unlike DXA/aBMD, accounted for bone differences due to sex.

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“…Furthermore, ref. [129,209] assume that the proximal femur behaves as a CLE-material up to fracture, i.e., that the post-yield behaviour, i.e., the plastic behaviour, can be neglected.…”

Section: Constitutive Equationmentioning

confidence: 99%

“…In Table 2(8A), many of the surveyed references estimate BCs from very simple accident models. A specific force is simply and directly applied on the femur's head and said to be the representation of a side-ways fall or stance position [91,105,106,[108][109][110][111][112]121,122,129]. Figure 1 illustrates the PDEs that describe (or "govern", see Remark 24) the solid continuum mechanics.…”

Section: Highlightmentioning

confidence: 99%

Patient-Specific Bone Multiscale Modelling, Fracture Simulation and Risk Analysis—A Survey

et al. 2019

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This paper provides a starting point for researchers and practitioners from biology, medicine, physics and engineering who can benefit from an up-to-date literature survey on patient-specific bone fracture modelling, simulation and risk analysis. This survey hints at a framework for devising realistic patient-specific bone fracture simulations. This paper has 18 sections: Section 1 presents the main interested parties; Section 2 explains the organzation of the text; Section 3 motivates further work on patient-specific bone fracture simulation; Section 4 motivates this survey; Section 5 concerns the collection of bibliographical references; Section 6 motivates the physico-mathematical approach to bone fracture; Section 7 presents the modelling of bone as a continuum; Section 8 categorizes the surveyed literature into a continuum mechanics framework; Section 9 concerns the computational modelling of bone geometry; Section 10 concerns the estimation of bone mechanical properties; Section 11 concerns the selection of boundary conditions representative of bone trauma; Section 12 concerns bone fracture simulation; Section 13 presents the multiscale structure of bone; Section 14 concerns the multiscale mathematical modelling of bone; Section 15 concerns the experimental validation of bone fracture simulations; Section 16 concerns bone fracture risk assessment. Lastly, glossaries for symbols, acronyms, and physico-mathematical terms are provided.

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Study of sex differences in the association between hip fracture risk and body parameters by DXA-based biomechanical modeling

Cited by 27 publications

References 93 publications

A novel sideways fall simulator to study hip fractures ex vivo

A novel sideways fall simulator to study hip fractures ex vivo

Are DXA/aBMD and QCT/FEA Stiffness and Strength Estimates Sensitive to Sex and Age?

Patient-Specific Bone Multiscale Modelling, Fracture Simulation and Risk Analysis—A Survey

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