@article{ref1,
title="Multiple loading conditions analysis can improve the association between finite element bone strength estimates and proximal femur fractures: a preliminary study in elderly women",
journal="Bone",
year="2014",
author="Falcinelli, Cristina and Schileo, Enrico and Balistreri, Luca and Baruffaldi, Fabio and Bordini, Barbara and Viceconti, Marco and Albisinni, Ugo and Ceccarelli, Francesco and Milandri, Luigi and Toni, Aldo and Taddei, Fulvia",
volume="67",
number="",
pages="71-80",
abstract="This is a preliminary case-control study on osteopenic/osteoporotic elderly women, testing the association of proximal femur fracture with minimum femoral strength, as derived from finite element (FE) analysis in multiple loading conditions. Fracture cases (n=22) in acute conditions were enrolled among low-trauma fractures admitted in various hospitals in the Emilia Romagna region, Italy. Women with no history of low-trauma fractures were enrolled as controls (n=33). Patients were imaged with DXA to obtain aBMD, and with a bilateral full femur CT scan. FE-strength was derived in stance and fall configurations: (i) as the minimum strength among those obtained for multiple loading conditions spanning a domain of plausible force directions, and (ii) as the strength associated to the most commonly used single loading conditions. The association of FE-strength and aBMD with fractures was tested with logistic regression models, deriving Odds Ratios (ORs) and the Area Under the Receiver Operating Characteristic Curve (AUC). FE-strength from multiple loading conditions better classified fracture cases from controls (OR per SD change=9.6, 95% CI=3.0-31.3, AUC=0.87 in stance; OR=9.5, 95% CI=2.9-31.2, AUC=0.88 in fall) compared to aBMD (OR=3.6, 95% CI=1.6-8.2, AUC=0.79 for total femur aBMD), while FE-strength results from the mot commonly used single loading conditions were similar to aBMD. Only FE-strength from multiple loading conditions remained significant in age- and aBMD-adjusted models (OR=10.5, 95% CI=1.8-61.3, AUC=0.95). In summary, we highlighted the importance of considering different loading conditions to identify bone weakness, and confirmed that femoral FE-strength estimates may add value to aBMD predictions in elderly osteopenic/osteoporotic women.<p /> <p>Language: en</p>",
language="en",
issn="8756-3282",
doi="10.1016/j.bone.2014.06.038",
url="http://dx.doi.org/10.1016/j.bone.2014.06.038"
}