Finite Element Analysis of the Proximal Femur and Hip Fracture Risk in Older Men
Finite Element Analysis of the Proximal Femur and Hip Fracture Risk in Older Men
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DOI：
10.1359/jbmr.081201
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发表时间：
2009-03-01
影响因子：
6.2
通讯作者：
Keaveny, Tony M.
中科院分区：
文献类型：
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作者：
Orwoll, Eric S.;Marshall, Lynn M.;Keaveny, Tony M.
低面积 BMD (aBMD) 与髋部骨折风险增加相关，但许多髋部骨折发生在 aBMD 不低的人身上。 QCT 扫描的有限元 (FE) 分析提供了髋部力量的测量。我们研究了老年男性 FE 测量与髋部骨折风险的关联。对所有首次髋部骨折 (n = 40) 和来自 3549 名 65 岁以上社区居住男性的非骨折病例的随机样本 (n = 210) 进行的前瞻性病例队列研究使用了髋部基线 QCT 扫描（平均随访时间为 5.6 年）。分析包括 DXA 的强度有限元测量、载荷与强度比以及 BMD。通过比例风险回归估计髋部骨折的风险比（HR）。股骨强度（HR/SD 变化 = 13.1；95% CI：3.9-43.5）和负荷强度比（HR = 4.0；95% CI：2.7-6.0）与髋部骨折风险密切相关，DXA 测量的 aBMD 也是如此（HR = 5.1；95% CI：2.8-9.2）。调整年龄、BMI和研究地点后，相关性仍然显着（股骨强度 HR = 6.5，95% CI：2.3-18.3；负荷强度比 HR = 4.3，95% CI：2.5-7.4；aBMD HR = 4.4，95% CI：2.1-9.1）。当额外调整 aBMD 时，负载强度比仍然与骨折显着相关（HR = 3.1.，95% CI：1.6-6.1）。这些结果提供了对髋部骨折病因学的深入了解，并证明了基于有限元的 QCT 扫描生物力学分析能够前瞻性预测男性髋部骨折。
Low areal BMD (aBMD) is associated with increased risk of hip fracture, but many hip fractures occur in persons without low aBMD. Finite element (FE) analysis of QCT scans provides a measure of hip strength. We studied the association of FE measures with risk of hip fracture in older men. A prospective case-cohort study of all first hip fractures (n = 40) and a random sample (n = 210) of nonfracture cases from 3549 community-dwelling men >= 65 yr of age used baseline QCT scans of the hip (mean follow-up, 5.6 yr). Analyses included FE measures of strength and load-to-strength ratio and BMD by DXA. Hazard ratios (HRs) for hip fracture were estimated with proportional hazards regression. Both femoral strength (HR per SD change = 13.1; 95% CI: 3.9-43.5) and the load-to-strength ratio (HR = 4.0; 95% CI: 2.7-6.0) were strongly associated with hip fracture risk, as was aBMD as measured by DXA (HR = 5.1; 95% CI: 2.8-9.2). After adjusting for age, BMI, and study site, the associations remained significant (femoral strength HR = 6.5, 95% CI: 2.3-18.3; load-to-strength ratio HR = 4.3, 95% CI: 2.5-7.4; aBMD HR = 4.4, 95% CI: 2.1-9.1). When adjusted additionally for aBMD, the load-to-strength ratio remained significantly associated with fracture (HR = 3.1., 95% CI: 1.6-6.1). These results provide insight into hip fracture etiology and demonstrate the ability of FE-based biomechanical analysis of QCT scans to prospectively predict hip fractures in men.