PMID- 30293203
OWN - NLM
STAT- MEDLINE
DCOM- 20190527
LR  - 20190527
IS  - 1617-7940 (Electronic)
IS  - 1617-7940 (Linking)
VI  - 18
IP  - 1
DP  - 2019 Feb
TI  - The application of finite element modelling based on clinical pQCT for 
      classification of fracture status.
PG  - 245-260
LID - 10.1007/s10237-018-1079-7 [doi]
AB  - Fracture risk assessment using dual-energy X-ray absorptiometry (DXA) frequently 
      fails to diagnose osteoporosis amongst individuals who later experience fragility 
      fractures. Hence, more reliable techniques that improve the prediction of 
      fracture risk are needed. In this study, we evaluated a finite element (FE) 
      modelling framework based on clinical peripheral quantitative computed tomography 
      (pQCT) imaging of the tibial epiphysis and diaphysis to predict the stiffness at 
      these locations in compression, shear, torsion and bending. The ability of these 
      properties to identify a group of women who had recently sustained a low-trauma 
      fracture from an age- and weight-matched control group was determined and 
      compared to clinical pQCT and DXA properties and structural properties based on 
      composite beam theory. The predicted stiffnesses derived from the FE models and 
      composite beam theory were significantly different (p < 0.05) between the control 
      and fracture groups, whereas no meaningful differences were observed using DXA 
      and for the stress-strain indices (SSIs) derived using pQCT. The diagnostic 
      performance of each property was assessed by the odds ratio (OR) and the area 
      under the receiver operating curve (AUC), and both were greatest for the 
      FE-predicted shear stiffness (OR 16.09, 95% CI 2.52-102.56, p = 0.003) (AUC: 
      0.80, 95% CI 0.67-0.93). The clinical pQCT variable total density (rho(tot)) and a 
      number of structural and FE-predicted variables had a similar probability of 
      correct classification between the control and fracture groups (i.e. ORs and AUCs 
      with mean values greater than 5.00 and 0.80, respectively). In general, the 
      diagnostic characteristics were lower for variables derived using DXA and for the 
      SSIs (i.e. ORs and AUCs with mean values of 1.65-2.98 and 0.64-0.71, 
      respectively). For all properties considered, the trabecular-dominant tibial 
      epiphysis exhibited enhanced classification characteristics, as compared to the 
      cortical-dominant tibial diaphysis. The results of this study demonstrate that 
      bone properties may be derived using FE modelling that have the potential to 
      enhance fracture risk assessment using conventional pQCT or DXA instruments in 
      clinical settings.
FAU - Robinson, Dale L
AU  - Robinson DL
AD  - Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, 
      3010, Australia.
FAU - Jiang, Hongyuan
AU  - Jiang H
AD  - Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 
      Melbourne, VIC, Australia.
FAU - Song, Qichun
AU  - Song Q
AD  - Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 
      Melbourne, VIC, Australia.
AD  - Department of Orthopaedics, 2nd Affiliated Hospital, Xi'an Jiaotong University, 
      Xi'an, China.
FAU - Yates, Christopher
AU  - Yates C
AD  - Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, 
      VIC, Australia.
FAU - Lee, Peter Vee Sin
AU  - Lee PVS
AD  - Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, 
      3010, Australia. pvlee@unimelb.edu.au.
FAU - Wark, John D
AU  - Wark JD
AD  - Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 
      Melbourne, VIC, Australia.
AD  - Bone and Mineral Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.
LA  - eng
PT  - Journal Article
DEP - 20181006
PL  - Germany
TA  - Biomech Model Mechanobiol
JT  - Biomechanics and modeling in mechanobiology
JID - 101135325
SB  - IM
MH  - Absorptiometry, Photon
MH  - Area Under Curve
MH  - Female
MH  - *Finite Element Analysis
MH  - Fractures, Bone/*classification/*diagnostic imaging
MH  - Humans
MH  - Middle Aged
MH  - Odds Ratio
MH  - ROC Curve
MH  - Stress, Mechanical
MH  - *Tomography, X-Ray Computed
OTO - NOTNLM
OT  - Bone strength
OT  - FE modelling
OT  - Fracture status
OT  - pQCT
EDAT- 2018/10/08 06:00
MHDA- 2019/05/28 06:00
CRDT- 2018/10/08 06:00
PHST- 2018/04/15 00:00 [received]
PHST- 2018/09/17 00:00 [accepted]
PHST- 2018/10/08 06:00 [pubmed]
PHST- 2019/05/28 06:00 [medline]
PHST- 2018/10/08 06:00 [entrez]
AID - 10.1007/s10237-018-1079-7 [pii]
AID - 10.1007/s10237-018-1079-7 [doi]
PST - ppublish
SO  - Biomech Model Mechanobiol. 2019 Feb;18(1):245-260. doi: 
      10.1007/s10237-018-1079-7. Epub 2018 Oct 6.