Citation

Amin S, Kopperdhal DL, Melton LJ, Achenbach SJ, Therneau TM, Riggs BL, Keaveny TM, Khosla S. J. Bone Miner. Res. 2011; 26(7): 1593-1600.

Affiliation

Divisions of Rheumatology and, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN; Epidemiology and Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN. amin.shreyasee@mayo.edu.

Copyright

(Copyright © 2011, American Society for Bone and Mineral Research)

DOI

10.1002/jbmr.347

PMID

21305605

PMCID

PMC3201782

Abstract

Finite element (FE) analysis of quantitative computed tomography (QCT) scans can estimate site-specific whole bone strength. However, it is uncertain whether the site-specific detail included in FE-estimated proximal femur (hip) strength can determine fracture risk at sites with different biomechanical characteristics. To address this question, we used FE analysis of proximal femur QCT scans to estimate hip strength and load-to-strength ratio during a simulated sideways fall, and measured total hip areal and volumetric bone mineral density (aBMD and vBMD) from QCT images, in an age-stratified, random sample of community adults, age ≥ 35 years. Among 314 women (mean age ± SD: 61 ± 15 years; 235 postmenopausal) and 266 men (62 ± 16 years), 139 women and 104 men had any prevalent fracture, while 55 women and 28 men had a prevalent osteoporotic fracture that had occurred ≥ age 35 years. Odds ratios by age-adjusted logistic regression analysis for prevalent overall and osteoporotic fractures each were similar for FE hip strength and load-to-strength ratio, as well as total hip aBMD and vBMD. C-statistics (estimated areas under ROC curves) were also similar (e.g., 0.84-0.85 [women] and 0.75-0.78 [men] for osteoporotic fractures). In women and men, the association with prevalent osteoporotic fractures increased below an estimated hip strength of ∼3000 N. Despite its site-specific nature, FE-estimated hip strength worked equally well at predicting prevalent overall, and osteoporotic, fractures. Furthermore, an estimated hip strength below 3000 N may represent a critical level of systemic skeletal fragility in both sexes that warrants further investigation. © 2011 American Society for Bone and Mineral Research.

Language: en