Predicting Fragilty Fractures Using Hip Radiographs

描述（由申请人提供）：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，治疗髋部骨折的年费用预计将增加6倍，达到600亿美元以上。准确估计个体的骨质疏松性髋部骨折风险的能力是预防髋部骨折预期增加的关键，因为它将识别那些需要最有效的骨折复位治疗的个体。骨密度（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效用有限。这是因为个体骨折风险也受到局部骨结构和结构、骨转换、皮质厚度和跌倒生物力学的强烈影响。我们最近开发了（SBIR第1阶段）非侵入性自动成像技术，使用普通射线照片，可以测量皮质和小梁参数，这些参数与3D uCT测量的参数相当。一般来说，它涉及X射线数字化、感兴趣区域的识别、小梁提取、背景减除以获得小梁结构的图像以及这些结构的二进制化加二进制化。使用算法测量小梁结构的参数。在尸体股骨近端核心的普通X线片中，骨小梁结构的2D测量值与3D mu/CT测量值具有良好的相关性。这些2D测量值还与施加到这些芯以及整个尸体近端股骨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）。我们的假设是：有针对性的，重点评估骨结构的髋关节X射线产生了极大的提高能力，预测骨质疏松性骨折相比，BMD测量。为了评估这一假设的有效性，我们将确定该项目第一阶段开发的技术是否能够区分健康的绝经后妇女和回顾性经历过骨质疏松性骨折的绝经后妇女。我们还将测试基于X射线的骨微观结构和骨几何结构测量的短期体内再现性，方法是在相同的组中测量两次，间隔不超过两周，作为个体再现性误差的均方根。

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.