Preventing Osteoporotic Hip Fractures by Accurately Predicting Future Fractures

描述(申请人提供)：髋部骨折是骨质疏松症(OP)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。我们最近开发了使用普通X线片的非侵入性自动化成像技术，可以测量与3D UCT测量的皮质和小梁参数相当的参数。这些2D测量与应用于身体股骨近端髓核以及整个股骨近端的生物力学破坏载荷相关。此外，在相同的股骨近端，结构参数的2D映射和分水岭边界检测似乎可以高度准确地预测骨质疏松骨折线的位置。因此，对预测骨折部位的骨小梁参数进行有针对性的测量，可以比那些不在预测骨折部位的骨小梁参数更精确和准确地估计破坏载荷。预置Fast Track的第一阶段旨在表明，这些观察结果不仅仅是理论上的，它们可以用来制定第二阶段身体骨折负荷值的参考量表，以及预测个性化骨折风险的生物力学组件。最后，这项技术将被用于根据加州大学旧金山分校对骨质疏松性骨折(SOF)进行的前瞻性研究获得的骨盆X光照片来预测髋部骨折。因此，目前的Fast Track第一阶段和第二阶段应用程序建议开发强大的新技术，该技术将识别髋部骨折的高危OP患者，以便他们能够得到明确的治疗。预计这一行动可以显著降低这种普遍疾病的发病率、死亡率和成本。

DESCRIPTION (provided by applicant): Hip fracture is the most serious consequence of osteoporosis (OP). 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 non- invasive automated imaging technology using ordinary radiographs that can measure cortical and trabecular parameters that are comparable to those measured by 3D uCT. Those 2D measurements correlated with biomechanical failure loads applied to cadaver proximal femoral bone cores as well to whole cadaver proximal femora. Furthermore, 2D mapping of structural parameters and watershed boundary detection in those same proximal femora appear to predict the location of osteoporotic fracture lines with a high degree of accuracy. Thus targeted measurement of trabecular parameters at a predicted fracture site could yield more precise and accurate estimates of failure load than those that are not at a predicted fracture site. Phase 1 of the preset Fast Track is designed to show that these observations are more than theoretical and that they can be used to develop a reference scale of cadaver fracture load values in Phase 2, along with a biomechanical component to predict individualized fracture risk. Finally that technology will be used attempt to predict hip fracture from pelvic radiographs obtained in the University of California, San Francisco prospective Study of Osteoporotic Fractures (SOF). Thus the present Fast Track Phase 1 and Phase 2 applications propose to develop powerful new technology that would identify individuals with OP at high risk for hip fracture so that they can be definitively treated. It is expected that this action could markedly reduce the morbidity, mortality and cost of this pervasive disease.