Dr Keaveny has a financial interest in O.N. Diagnostics, and both he and the company may benefit from the results of this research. Dr Kopperdahl and Mr Hoffmann have equity interests in and are employees of O.N. Diagnostics. All other authors state that they have no conflicts of interest.
Finite Element Analysis of the Proximal Femur and Hip Fracture Risk in Older Men†
Article first published online: 1 DEC 2008
Copyright © 2009 ASBMR
Journal of Bone and Mineral Research
Volume 24, Issue 3, pages 475–483, March 2009
How to Cite
Orwoll, E. S., Marshall, L. M., Nielson, C. M., Cummings, S. R., Lapidus, J., Cauley, J. A., Ensrud, K., Lane, N., Hoffmann, P. R., Kopperdahl, D. L. and Keaveny, T. M. (2009), Finite Element Analysis of the Proximal Femur and Hip Fracture Risk in Older Men. J Bone Miner Res, 24: 475–483. doi: 10.1359/jbmr.081201
- Issue published online: 4 DEC 2009
- Article first published online: 1 DEC 2008
- Manuscript Accepted: 28 OCT 2008
- Manuscript Revised: 12 AUG 2008
- Manuscript Received: 16 APR 2008
- bone strength;
- fracture risk assessment;
Low areal BMD (aBMD) is associated with increased risk of hip fracture, but many hip fractures occur in persons without low aBMD. Finite element (FE) analysis of QCT scans provides a measure of hip strength. We studied the association of FE measures with risk of hip fracture in older men. A prospective case-cohort study of all first hip fractures (n = 40) and a random sample (n = 210) of nonfracture cases from 3549 community-dwelling men ≥65 yr of age used baseline QCT scans of the hip (mean follow-up, 5.6 yr). Analyses included FE measures of strength and load-to-strength ratio and BMD by DXA. Hazard ratios (HRs) for hip fracture were estimated with proportional hazards regression. Both femoral strength (HR per SD change = 13.1; 95% CI: 3.9–43.5) and the load-to-strength ratio (HR = 4.0; 95% CI: 2.7–6.0) were strongly associated with hip fracture risk, as was aBMD as measured by DXA (HR = 5.1; 95% CI: 2.8–9.2). After adjusting for age, BMI, and study site, the associations remained significant (femoral strength HR = 6.5, 95% CI: 2.3–18.3; load-to-strength ratio HR = 4.3, 95% CI: 2.5–7.4; aBMD HR = 4.4, 95% CI: 2.1–9.1). When adjusted additionally for aBMD, the load-to-strength ratio remained significantly associated with fracture (HR = 3.1, 95% CI: 1.6–6.1). These results provide insight into hip fracture etiology and demonstrate the ability of FE-based biomechanical analysis of QCT scans to prospectively predict hip fractures in men.