HIP FRACTURE RISK PREDICTION BY QDR

通过 QDR 预测髋部骨折风险

• 批准号: 2699796
• 负责人: WILSON C HAYES
• 金额: $ 21.1万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 1995
• 资助国家: 美国
• 起止时间: 1995-07-01 至 1999-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2699796
• 关键词: accidental falls; balance; behavioral habituation /sensitization; biomechanics; body composition; body height; body weight; bone density; clinical research; densitometry; dietary calcium; disease /disorder proneness /risk; femur fracture; functional ability; hip fractures; human old age (65+); human subject; injury prevention; muscle strength; nutrition related tag; osteoporosis; phosphonate; posture; prognosis; vitamin D

DESCRIPTION (Adapted from the applicant's Abstract): Age-related hip fractures are an escalating public health problem, with over 280,000 hip fractures occurring each year in the US and costs in excess of $10 billion. The long-term objectives of this application are to understand the biomechanical factors that influence hip fracture risk, and to develop non-invasive densitometric measures that can be used clinically for fracture risk prediction. During the previous funding period, the applicant demonstrated that strong associations between bone mineral density (BMD) and fracture load hold over a wide range of age and loading rates. He has also shown that factors related to fall severity (fall direction, impact site, and potential energy) exert a strong and potentially dominant influence on fracture risk and touch on a domain of risk independent of bone density. To address the confounding influences of body habitus and fall severity, a composite index has been proposed that the applicant calls the factor of risk. The applicant has shown, in a limited, retrospective, case-control study, not only a strong association between the factor of risk and hip fracture, but a stronger association with hip fracture than femoral BMD alone. The applicant now proposes to extend these studies in several important ways. Aim 1 will examine the role of muscle forces, both from fall- related impact and during several common activities of daily living, thereby estimating the factor of risk for loads that could cause spontaneous fractures. Aim 2 will develop methods for predicting failure of the proximal femur using finite element models. These methods wull be used to examine the effect of loading conditions and age- related density changes on fracture risk. These models will also be used to examine potential reductions in fracture risk induced by bisphosphonate therapy. In Aim 3, the confounding influence of body habitus on hip fracture risk will be characterized by conducting a series of ex vivo experiments using soft tissues and matching femurs from donors of known height and weight. The findings will help refine their estimates of the factor of risk for a given body habitus, gender and fall direction. Finally, in Aim 4, the factor of risk will be tested by conducting a prospective study of elderly nursing home subjects. At baseline, subject height, weight, body mass index and trochanteric soft tissue thickness will be assessed to estimate the hip impact forces from a fall (numerator of factor of risk) and hip bone mineral density to estimate femoral strength (the denominator of factor of risk). The applicant hypothesizes that the factor of risk will not only associate strongly with hip fracture incidence, but will be a better predictor of hip fracture risk than BMD alone. With intervention strategies based on an improved understanding of the complex interplay between fall biomechanics and bone fragility, the applicant believes there is hope that the growing epidemic of hip fractures among the elderly can be substantially abated.

描述（改编自申请人的摘要）：与年龄相关的髋关节 骨折是一个日益严重的公共卫生问题，超过 280,000 名髋骨骨折患者 美国每年都会发生骨折，费用超过 10 美元 十亿。 该应用程序的长期目标是了解 影响髋部骨折风险的生物力学因素，以及 开发可用于临床的非侵入性密度测量方法 用于骨折风险预测。 在上一个资助期间， 申请人证明，骨矿物质之间有很强的关联 密度（BMD）和断裂载荷在很宽的年龄范围内保持 装载率。 他还表明，与跌倒严重程度相关的因素 （坠落方向、撞击地点和势能）发挥出强大且 对骨折风险和领域接触的潜在主导影响 风险与骨密度无关。 为了解决混杂问题 身体习惯和跌倒严重程度的影响，综合指数 建议申请人称之为风险因素。 申请人 在一项有限的回顾性病例对照研究中表明，不仅 风险因素与髋部骨折之间有很强的相关性，但 与髋部骨折的相关性比单独的股骨 BMD 更强。 这 申请人现在提议将这些研究扩展到几个重要的领域 方式。 目标 1 将检查肌肉力量的作用，包括跌倒- 相关影响以及日常生活中的一些常见活动， 从而估计可能导致的负载风险因素 自发性骨折。 目标 2 将开发预测方法 使用有限元模型分析股骨近端失效。 这些 方法将用于检查负载条件和年龄的影响 骨折风险的相关密度变化。 这些型号也将 用于检查由以下因素引起的骨折风险的潜在降低 双膦酸盐治疗。 在目标 3 中，身体的混杂影响 髋部骨折风险的习性将通过进行 使用软组织和匹配股骨进行一系列离体实验 来自已知身高和体重的捐赠者。 研究结果将有助于完善 他们对特定身体习惯、性别的风险因素的估计 和下降方向。 最后，在目标 4 中，风险因素为 通过对老年疗养院进行前瞻性研究进行测试 科目。 在基线时，受试者身高、体重、体重指数和 将评估转子软组织厚度以估计髋关节 跌倒（风险因素分子）和髋骨的冲击力 用于估计股骨强度的矿物质密度（因子的分母 的风险）。 申请人假设风险因素不会 只与髋部骨折发生率密切相关，但会是 比单独的骨密度更好地预测髋部骨折风险。 有干预 基于对复杂相互作用的更好理解的策略 申请人认为，在跌倒生物力学和骨骼脆弱性之间 希望髋部骨折在人群中日益流行 老年人可大幅减少。