Male–female differences in the association between incident hip fracture and proximal femoral strength: A finite element analysis study
Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE)...
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| Published in | Bone (New York, N.Y.) Vol. 48; no. 6; pp. 1239 - 1245 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Amsterdam
Elsevier Inc
01.06.2011
Elsevier |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE) analysis. To evaluate this technique for predicting hip fracture in older men and women, we performed a nested age- and sex-matched case–control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) QCT scans of 5500 subjects were obtained. During 4–7
years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as age- and sex-matched controls. FE-strength of the left hip of each subject for stance (F
Stance) and posterolateral fall (F
Fall) loading, and total femur areal bone mineral density (aBMD) were computed from the QCT data. F
Stance and F
Fall in incident hip fracture subjects were 13%–25% less than in control subjects (p
≤
0.006) after controlling for demographic parameters. The difference between FE strengths of fracture and control subjects was disproportionately greater in men (stance, 22%; fall, 25%) than in women (stance, 13%; fall, 18%) (p
≤
0.033), considering that F
Stance and F
Fall in fracture subjects were greater in men than in women (p
<
0.001). For men, F
Stance was associated with hip fracture after accounting for aBMD (p
=
0.013). These data indicate that F
Stance provides information about fracture risk that is beyond that provided by aBMD (p
=
0.013). These findings support further exploration of possible sex differences in the predictors of hip fracture and of sex-specific strategies for using FE analysis to manage osteoporosis.
► We performed a prospective study of hip fracture in a group of older men and women. ► Finite element-computed hip strength in fracture and control subjects was obtained. ► Men and women with fractures had lower hip bone strength than control subjects. ► The reduction in strength due to fracture was greater in men than in women. ► Further study of sex-differences in hip strength and fracture risk is warranted. |
|---|---|
| AbstractList | Hip fracture risk is usually evaluated using dual energy x-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE) analysis. To evaluate this technique for predicting hip fracture in older men and women, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) QCT scans of 5500 subjects were obtained. During 4–7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as age- and sex-matched controls. FE-strength of the left hip of each subject for stance (F
Stance
) and posterolateral fall (F
Fall
) loading, and total femur areal bone mineral density (aBMD) were computed from the QCT data. F
Stance
and F
Fall
in incident hip fracture subjects were 13%–25% less than in control subjects (p≤0.006) after controlling for demographic parameters. The difference between FE strengths of fracture and control subjects was disproportionately greater in men (stance, 22%; fall, 25%) than in women (stance, 13%; fall, 18%) (p≤0.033), considering that F
Stance
and F
Fall
in fracture subjects were greater in men than in women (p<0.001). For men, F
Stance
was associated with hip fracture after accounting for aBMD (p=0.013). These data indicate that F
Stance
provides information about fracture risk that is beyond that provided by aBMD (p=0.013). These findings support further exploration of possible sex differences in the predictors of hip fracture and of sex-specific strategies for using FE analysis to manage osteoporosis. Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE) analysis. To evaluate this technique for predicting hip fracture in older men and women, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) QCT scans of 5500 subjects were obtained. During 4-7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as age- and sex-matched controls. FE-strength of the left hip of each subject for stance (F(Stance)) and posterolateral fall (F(Fall)) loading, and total femur areal bone mineral density (aBMD) were computed from the QCT data. F(Stance) and F(Fall) in incident hip fracture subjects were 13%-25% less than in control subjects (p ≤ 0.006) after controlling for demographic parameters. The difference between FE strengths of fracture and control subjects was disproportionately greater in men (stance, 22%; fall, 25%) than in women (stance, 13%; fall, 18%) (p ≤ 0.033), considering that F(Stance) and F(Fall) in fracture subjects were greater in men than in women (p < 0.001). For men, F(Stance) was associated with hip fracture after accounting for aBMD (p = 0.013). These data indicate that F(Stance) provides information about fracture risk that is beyond that provided by aBMD (p = 0.013). These findings support further exploration of possible sex differences in the predictors of hip fracture and of sex-specific strategies for using FE analysis to manage osteoporosis. Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE) analysis. To evaluate this technique for predicting hip fracture in older men and women, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) QCT scans of 5500 subjects were obtained. During 4-7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as age- and sex-matched controls. FE-strength of the left hip of each subject for stance (F-Stance) and posterolateral fall (F-Fall) loading, and total femur areal bone mineral density (aBMD) were computed from the QCT data. F-Stance and F-Fall in incident hip fracture subjects were 13%-25% less than in controlsubjects (p <= 0.006) after controlling for demographic parameters. The difference between FE strengths of fracture and control subjects was disproportionately greater ill men (stance, 22%; fall, 25%) than in women (stance, 13%; fall, 18%) (p <= 0.033), considering that Fstar,ce and FFall in fracture subjects were greater in men than in women ( p < 0.001). For men, F-Stance was associated with hip fracture after accounting for aBMD (p = 0.013). These data indicate that F-Stance provides information about fracture risk that is beyond that provided by aBMD (p = 0.013). These findings support further exploration of possible sex differences in the predictors of hip fracture and of sex-specific strategies for using FE analysis to manage osteoporosis. (C) 2011 Elsevier Inc. All rights reserved. Abstract Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE) analysis. To evaluate this technique for predicting hip fracture in older men and women, we performed a nested age- and sex-matched case–control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) QCT scans of 5500 subjects were obtained. During 4–7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as age- and sex-matched controls. FE-strength of the left hip of each subject for stance (FStance ) and posterolateral fall (FFall ) loading, and total femur areal bone mineral density (aBMD) were computed from the QCT data. FStance and FFall in incident hip fracture subjects were 13%–25% less than in control subjects (p ≤ 0.006) after controlling for demographic parameters. The difference between FE strengths of fracture and control subjects was disproportionately greater in men (stance, 22%; fall, 25%) than in women (stance, 13%; fall, 18%) (p ≤ 0.033), considering that FStance and FFall in fracture subjects were greater in men than in women (p < 0.001). For men, FStance was associated with hip fracture after accounting for aBMD (p = 0.013). These data indicate that FStance provides information about fracture risk that is beyond that provided by aBMD (p = 0.013). These findings support further exploration of possible sex differences in the predictors of hip fracture and of sex-specific strategies for using FE analysis to manage osteoporosis. Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE) analysis. To evaluate this technique for predicting hip fracture in older men and women, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) QCT scans of 5500 subjects were obtained. During 4-7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as age- and sex-matched controls. FE-strength of the left hip of each subject for stance (F-Stance) and posterolateral fall (F-Fall) loading, and total femur areal bone mineral density (aBMD) were computed from the QCT data. F-Stance and F-Fall in incident hip fracture subjects were 13%-25% less than in control subjects (p <= 0.006) after controlling for demographic parameters. The difference between FE strengths of fracture and control subjects was disproportionately greater ill men (stance, 22%; fall, 25%) than in women (stance, 13%; fall, 18%) (p <= 0.033), considering that Fstar,ce and FFall in fracture subjects were greater in men than in women ( p < 0.001). For men, F-Stance was associated with hip fracture after accounting for aBMD (p = 0.013). These data indicate that F-Stance provides information about fracture risk that is beyond that provided by aBMD (p = 0.013). These findings support further exploration of possible sex differences in the predictors of hip fracture and of sex-specific strategies for using FE analysis to manage osteoporosis. (C) 2011 Elsevier Inc. All rights reserved. Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE) analysis. To evaluate this technique for predicting hip fracture in older men and women, we performed a nested age- and sex-matched case–control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) QCT scans of 5500 subjects were obtained. During 4–7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as age- and sex-matched controls. FE-strength of the left hip of each subject for stance (F Stance) and posterolateral fall (F Fall) loading, and total femur areal bone mineral density (aBMD) were computed from the QCT data. F Stance and F Fall in incident hip fracture subjects were 13%–25% less than in control subjects (p ≤ 0.006) after controlling for demographic parameters. The difference between FE strengths of fracture and control subjects was disproportionately greater in men (stance, 22%; fall, 25%) than in women (stance, 13%; fall, 18%) (p ≤ 0.033), considering that F Stance and F Fall in fracture subjects were greater in men than in women (p < 0.001). For men, F Stance was associated with hip fracture after accounting for aBMD (p = 0.013). These data indicate that F Stance provides information about fracture risk that is beyond that provided by aBMD (p = 0.013). These findings support further exploration of possible sex differences in the predictors of hip fracture and of sex-specific strategies for using FE analysis to manage osteoporosis. ► We performed a prospective study of hip fracture in a group of older men and women. ► Finite element-computed hip strength in fracture and control subjects was obtained. ► Men and women with fractures had lower hip bone strength than control subjects. ► The reduction in strength due to fracture was greater in men than in women. ► Further study of sex-differences in hip strength and fracture risk is warranted. Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE) analysis. To evaluate this technique for predicting hip fracture in older men and women, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) QCT scans of 5500 subjects were obtained. During 4-7years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as age- and sex-matched controls. FE-strength of the left hip of each subject for stance (FStance) and posterolateral fall (FFall) loading, and total femur areal bone mineral density (aBMD) were computed from the QCT data. FStance and FFall in incident hip fracture subjects were 13%-25% less than in control subjects (pa[control][curren]0.006) after controlling for demographic parameters. The difference between FE strengths of fracture and control subjects was disproportionately greater in men (stance, 22%; fall, 25%) than in women (stance, 13%; fall, 18%) (pa[control][curren]0.033), considering that FStance and FFall in fracture subjects were greater in men than in women (p<0.001). For men, FStance was associated with hip fracture after accounting for aBMD (p=0.013). These data indicate that FStance provides information about fracture risk that is beyond that provided by aBMD (p=0.013). These findings support further exploration of possible sex differences in the predictors of hip fracture and of sex-specific strategies for using FE analysis to manage osteoporosis. Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE) analysis. To evaluate this technique for predicting hip fracture in older men and women, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) QCT scans of 5500 subjects were obtained. During 4-7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as age- and sex-matched controls. FE-strength of the left hip of each subject for stance (F(Stance)) and posterolateral fall (F(Fall)) loading, and total femur areal bone mineral density (aBMD) were computed from the QCT data. F(Stance) and F(Fall) in incident hip fracture subjects were 13%-25% less than in control subjects (p ≤ 0.006) after controlling for demographic parameters. The difference between FE strengths of fracture and control subjects was disproportionately greater in men (stance, 22%; fall, 25%) than in women (stance, 13%; fall, 18%) (p ≤ 0.033), considering that F(Stance) and F(Fall) in fracture subjects were greater in men than in women (p < 0.001). For men, F(Stance) was associated with hip fracture after accounting for aBMD (p = 0.013). These data indicate that F(Stance) provides information about fracture risk that is beyond that provided by aBMD (p = 0.013). These findings support further exploration of possible sex differences in the predictors of hip fracture and of sex-specific strategies for using FE analysis to manage osteoporosis.Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures for proximal femoral strength. However, proximal femoral strength can best be estimated explicitly by combining QCT with finite element (FE) analysis. To evaluate this technique for predicting hip fracture in older men and women, we performed a nested age- and sex-matched case-control study in the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. Baseline (pre-fracture) QCT scans of 5500 subjects were obtained. During 4-7 years follow-up, 51 men and 77 women sustained hip fractures. Ninety-seven men and 152 women were randomly selected as age- and sex-matched controls. FE-strength of the left hip of each subject for stance (F(Stance)) and posterolateral fall (F(Fall)) loading, and total femur areal bone mineral density (aBMD) were computed from the QCT data. F(Stance) and F(Fall) in incident hip fracture subjects were 13%-25% less than in control subjects (p ≤ 0.006) after controlling for demographic parameters. The difference between FE strengths of fracture and control subjects was disproportionately greater in men (stance, 22%; fall, 25%) than in women (stance, 13%; fall, 18%) (p ≤ 0.033), considering that F(Stance) and F(Fall) in fracture subjects were greater in men than in women (p < 0.001). For men, F(Stance) was associated with hip fracture after accounting for aBMD (p = 0.013). These data indicate that F(Stance) provides information about fracture risk that is beyond that provided by aBMD (p = 0.013). These findings support further exploration of possible sex differences in the predictors of hip fracture and of sex-specific strategies for using FE analysis to manage osteoporosis. |
| Author | Kornak, J. Sigmarsdottir, A. Zhao, S. Siggeirsdottir, K. Karlsdottir, G. Sigurdsson, G. Oskarsdottir, D. Harris, T.B. Jonsson, B.Y. Sigurdsson, S. Gudnason, V. Lang, T.F. Keyak, J.H. Eiriksdottir, G. |
| AuthorAffiliation | i Landspitalinn University Hospital, Reykjavik, Iceland a Department of Radiological Sciences, University of California, Irvine, CA, USA d Icelandic Heart Association Research Institute, Kópavogur, Iceland c Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA f Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA b Department of Biomedical Engineering, University of California, Irvine, CA, USA j University of Iceland, Reykjavik, Iceland h Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA e Malmo University Hospital, Malmo, Sweden g Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA |
| AuthorAffiliation_xml | – name: d Icelandic Heart Association Research Institute, Kópavogur, Iceland – name: g Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA – name: f Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA – name: c Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA – name: j University of Iceland, Reykjavik, Iceland – name: a Department of Radiological Sciences, University of California, Irvine, CA, USA – name: e Malmo University Hospital, Malmo, Sweden – name: h Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA – name: b Department of Biomedical Engineering, University of California, Irvine, CA, USA – name: i Landspitalinn University Hospital, Reykjavik, Iceland |
| Author_xml | – sequence: 1 givenname: J.H. surname: Keyak fullname: Keyak, J.H. email: jhkeyak@uci.edu organization: Department of Radiological Sciences, University of California, Irvine, CA, USA – sequence: 2 givenname: S. surname: Sigurdsson fullname: Sigurdsson, S. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 3 givenname: G. surname: Karlsdottir fullname: Karlsdottir, G. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 4 givenname: D. surname: Oskarsdottir fullname: Oskarsdottir, D. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 5 givenname: A. surname: Sigmarsdottir fullname: Sigmarsdottir, A. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 6 givenname: S. surname: Zhao fullname: Zhao, S. organization: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA – sequence: 7 givenname: J. surname: Kornak fullname: Kornak, J. organization: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA – sequence: 8 givenname: T.B. surname: Harris fullname: Harris, T.B. organization: Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA – sequence: 9 givenname: G. surname: Sigurdsson fullname: Sigurdsson, G. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 10 givenname: B.Y. surname: Jonsson fullname: Jonsson, B.Y. organization: Malmo University Hospital, Malmo, Sweden – sequence: 11 givenname: K. surname: Siggeirsdottir fullname: Siggeirsdottir, K. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 12 givenname: G. surname: Eiriksdottir fullname: Eiriksdottir, G. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 13 givenname: V. surname: Gudnason fullname: Gudnason, V. organization: Icelandic Heart Association Research Institute, Kópavogur, Iceland – sequence: 14 givenname: T.F. surname: Lang fullname: Lang, T.F. organization: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25660904$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/21419886$$D View this record in MEDLINE/PubMed https://lup.lub.lu.se/record/1986087$$DView record from Swedish Publication Index oai:portal.research.lu.se:publications/346ab11e-37de-4fb2-a9b0-c850c405d4f6$$DView record from Swedish Publication Index |
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| Keywords | Osteoporosis F Fall Hip fracture Femur Quantitative computed tomography F Stance Finite element analysis Bone strength FE finite element analysis-computed proximal femoral strength for loading representing a fall onto the posterolateral aspect of the greater trochanter finite element analysis-computed proximal femoral strength for loading similar to that during single-limb stance finite element Proximal Radiodiagnosis Diseases of the osteoarticular system Male Fracture Epidemiology Trauma Hip Incidence Morphology Medical imagery Female Computerized axial tomography Bone Strength Quantitative analysis Finite element |
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| Snippet | Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures... Abstract Hip fracture risk is usually evaluated using dual energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate... Hip fracture risk is usually evaluated using dual energy x-ray absorptiometry (DXA) or quantitative computed tomography (QCT) which provide surrogate measures... |
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| SubjectTerms | Aged Biological and medical sciences Bone Density Bone strength Case-Control Studies Clinical Medicine Diseases of the osteoarticular system Female Femur Femur - diagnostic imaging Femur - physiopathology Finite Element Analysis Fundamental and applied biological sciences. Psychology Hip fracture Hip Fractures - diagnostic imaging Hip Fractures - physiopathology Humans Injuries of the limb. Injuries of the spine Klinisk medicin Male Medical and Health Sciences Medical sciences Medicin och hälsovetenskap Orthopaedics Orthopedics Ortopedi Osteoporosis Osteoporosis. Osteomalacia. Paget disease Quantitative computed tomography Sex Factors Tomography, X-Ray Computed Traumas. Diseases due to physical agents Vertebrates: anatomy and physiology, studies on body, several organs or systems |
| Title | Male–female differences in the association between incident hip fracture and proximal femoral strength: A finite element analysis study |
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