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Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT.
Osteoporos Int 2013; 24(5):1733-40OI

Abstract

High-resolution peripheral quantitative computed tomography (HR-pQCT) measurements of distal radius and tibia bone microarchitecture and finite element (FE) estimates of bone strength performed well at classifying postmenopausal women with and without previous fracture. The HR-pQCT measurements outperformed dual energy x-ray absorptiometry (DXA) at classifying forearm fractures and fractures at other skeletal sites.

INTRODUCTION

Areal bone mineral density (aBMD) is the primary measurement used to assess osteoporosis and fracture risk; however, it does not take into account bone microarchitecture, which also contributes to bone strength. Thus, our objective was to determine if bone microarchitecture measured with HR-pQCT and FE estimates of bone strength could classify women with and without low-trauma fractures.

METHODS

We used HR-pQCT to assess bone microarchitecture at the distal radius and tibia in 44 postmenopausal women with a history of low-trauma fracture and 88 age-matched controls from the Calgary cohort of the Canadian Multicentre Osteoporosis Study (CaMos) study. We estimated bone strength using FE analysis and simulated distal radius aBMD from the HR-pQCT scans. Femoral neck (FN) and lumbar spine (LS) aBMD were measured with DXA. We used support vector machines (SVM) and a tenfold cross-validation to classify the fracture cases and controls and to determine accuracy.

RESULTS

The combination of HR-pQCT measures of microarchitecture and FE estimates of bone strength had the highest area under the receiver operating characteristic (ROC) curve of 0.82 when classifying forearm fractures compared to an area under the curve (AUC) of 0.71 from DXA-derived aBMD of the forearm and 0.63 from FN and spine DXA. For all fracture types, FE estimates of bone strength at the forearm alone resulted in an AUC of 0.69.

CONCLUSION

Models based on HR-pQCT measurements of bone microarchitecture and estimates of bone strength performed better than DXA-derived aBMD at classifying women with and without prior fracture. In future, these models may improve prediction of individuals at risk of low-trauma fracture.

Authors+Show Affiliations

Schulich School of Engineering, University of Calgary, Calgary, Canada. kksnishi@ucalgary.caNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23179565

Citation

Nishiyama, K K., et al. "Women With Previous Fragility Fractures Can Be Classified Based On Bone Microarchitecture and Finite Element Analysis Measured With HR-pQCT." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 24, no. 5, 2013, pp. 1733-40.
Nishiyama KK, Macdonald HM, Hanley DA, et al. Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT. Osteoporos Int. 2013;24(5):1733-40.
Nishiyama, K. K., Macdonald, H. M., Hanley, D. A., & Boyd, S. K. (2013). Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 24(5), pp. 1733-40. doi:10.1007/s00198-012-2160-1.
Nishiyama KK, et al. Women With Previous Fragility Fractures Can Be Classified Based On Bone Microarchitecture and Finite Element Analysis Measured With HR-pQCT. Osteoporos Int. 2013;24(5):1733-40. PubMed PMID: 23179565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT. AU - Nishiyama,K K, AU - Macdonald,H M, AU - Hanley,D A, AU - Boyd,S K, Y1 - 2012/11/20/ PY - 2012/07/15/received PY - 2012/09/13/accepted PY - 2012/11/27/entrez PY - 2012/11/28/pubmed PY - 2013/11/1/medline SP - 1733 EP - 40 JF - Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA JO - Osteoporos Int VL - 24 IS - 5 N2 - UNLABELLED: High-resolution peripheral quantitative computed tomography (HR-pQCT) measurements of distal radius and tibia bone microarchitecture and finite element (FE) estimates of bone strength performed well at classifying postmenopausal women with and without previous fracture. The HR-pQCT measurements outperformed dual energy x-ray absorptiometry (DXA) at classifying forearm fractures and fractures at other skeletal sites. INTRODUCTION: Areal bone mineral density (aBMD) is the primary measurement used to assess osteoporosis and fracture risk; however, it does not take into account bone microarchitecture, which also contributes to bone strength. Thus, our objective was to determine if bone microarchitecture measured with HR-pQCT and FE estimates of bone strength could classify women with and without low-trauma fractures. METHODS: We used HR-pQCT to assess bone microarchitecture at the distal radius and tibia in 44 postmenopausal women with a history of low-trauma fracture and 88 age-matched controls from the Calgary cohort of the Canadian Multicentre Osteoporosis Study (CaMos) study. We estimated bone strength using FE analysis and simulated distal radius aBMD from the HR-pQCT scans. Femoral neck (FN) and lumbar spine (LS) aBMD were measured with DXA. We used support vector machines (SVM) and a tenfold cross-validation to classify the fracture cases and controls and to determine accuracy. RESULTS: The combination of HR-pQCT measures of microarchitecture and FE estimates of bone strength had the highest area under the receiver operating characteristic (ROC) curve of 0.82 when classifying forearm fractures compared to an area under the curve (AUC) of 0.71 from DXA-derived aBMD of the forearm and 0.63 from FN and spine DXA. For all fracture types, FE estimates of bone strength at the forearm alone resulted in an AUC of 0.69. CONCLUSION: Models based on HR-pQCT measurements of bone microarchitecture and estimates of bone strength performed better than DXA-derived aBMD at classifying women with and without prior fracture. In future, these models may improve prediction of individuals at risk of low-trauma fracture. SN - 1433-2965 UR - https://www.unboundmedicine.com/medline/citation/23179565/Women_with_previous_fragility_fractures_can_be_classified_based_on_bone_microarchitecture_and_finite_element_analysis_measured_with_HR_pQCT_ L2 - https://dx.doi.org/10.1007/s00198-012-2160-1 DB - PRIME DP - Unbound Medicine ER -