Predicting Fragilty Fractures Using Hip Radiographs

描述(申请人提供)：髋部骨折是骨质疏松症最严重的后果。2002年，治疗髋部骨折的费用占全国OP直接支出的63%，即超过100亿美元。到2050年，由于人口迅速老龄化，每年治疗髋部骨折的费用预计将增加6倍，达到600多亿美元。准确估计个人患骨质疏松性髋部骨折的风险的能力是防止髋部骨折预期增加的关键，因为它可以确定哪些人需要最有效的可用的骨折复位治疗。骨矿密度(BMD)测量目前用于诊断骨质疏松症。然而，它在预测髋部骨折方面的作用有限。这是因为个体骨折风险也受到局部骨结构和结构、骨转换、皮质厚度以及跌倒生物力学的强烈影响。我们最近开发了(SBIR第一阶段)非侵入性自动化成像技术，使用普通X光片可以测量与3D UCT测量的皮质和小梁参数相当的参数。一般来说，它包括X射线数字化、感兴趣区域的识别、小梁提取、背景减去以获得小梁结构的图像以及这些结构的二值化和骨架化。利用算法测量了骨小梁结构的参数。股骨近端骨芯普通X线片中骨小梁结构的2D测量结果与3DMU/CT测量结果具有良好的相关性。这些2D测量也与应用于这些核心以及整个身体股骨近端的生物力学失效载荷相关(J bone Min Res 2003；18 Suppl 2 Abst#1218，J bone Min Res；18 Suppl 2 Abst#107 2003)。我们在这项建议中的假设是：与骨密度测量相比，对髋部X-RAV中的骨结构进行有针对性的、重点的评估大大提高了预测骨质疏松性骨折的能力。为了评估这一假设的有效性，我们将确定在该项目第一阶段开发的技术是否有能力区分健康的绝经后妇女和回顾经历过骨质疏松性骨折的绝经后妇女。我们还将在体内测试我们的基于X射线的骨显微结构和骨几何测量的短期重复性，方法是在这些相同的组中测量两次，间隔不超过两周，作为单个重复性误差的均方根。

DESCRIPTION (provided by applicant): Hip fracture is the most serious consequence of osteoporosis. In 2002, the cost of treating hip fractures consumed 63% of the national direct expenditure for OP, or more than $10 billion. By 2050, due to a rapidly aging population, the annual cost of treating hip fractures is projected to increase 6 fold to more than $60 billion. The ability to accurately estimate an individual's risk of osteoporotic hip fracture is key in preventing the expected increase of hip fractures because it would identify those individuals needing the most potent available fracture reduction therapy. Bone Mineral Density (BMD) measurement is currently used for diagnosis of osteoporosis. However, it has only limited utility in predicting hip fracture. This is because Individual fracture risk is also strongly influenced by local bone architecture and structure, bone turnover, cortical thickness, and, fall biomechanics. We recently developed (SBIR Phase 1) non-invasive automated imaging technology using ordinary radiographs that can measure cortical and trabecular parameters that are comparable to those measured by 3D uCT. In general it involves x-ray digitization, identification of regions of interest, trabecular extraction, background subtraction to obtain an image of trabecular structures and binerization plus skeletonization of those structures. Parameters of trabecular structure are measured using algorithms. 2D measurements of trabecular structure in ordinary radiographs of cores of proximal cadaveric femora correlated well with 3D mu/CT measurements. Those 2D measurements also correlated with biomechanical failure loads applied to those cores as well to whole cadaver proximal femora(J Bone Min Res 2003 ;18 Suppl 2, Abst # 1218, J Bone Min Res; 18 Suppl 2 Abst # 107 2003.). Our hypotheses in this proposal are: targeted, focal assessment of bone structure in hip x-ravs yields vastly improved ability to predict osteoporotic fracture as compared with BMD measurements. To assess the validity of this hypothesis, we will determine if the technology developed in Phase I of this project has the ability to discriminate between healthy postmenopausal women and postmenopausal women who have retrospectively experienced osteoporotic fractures. We will also test the short term reproducibility in vivo of our x-ray based measurements of bone microstructure and bone geometry by measuring them twice in those same groups no more than two weeks apart as the root mean square of the individual reproducibility errors.