Prediction of proximal femur fracture risk from DXA images based on novel fracture indexes

ABSTRACT

Background: Osteoporosis is the degradation of bone microstructure that increase proximal femur risk of fracture. Current fracture prediction methods are based on the analysis of bone mineral density (BMD). Nevertheless, it has been shown that BMD alone cannot predict with certainty who will have a future hip fracture. The aim of this study was to develop a novel proximal femur fracture index approach including patient-specific geometrical and mechanical properties data to assess the femoral neck fracture risk. Methods: The patient-specific femoral neck geometry and data for the analysis were obtained from DXA scans. The fracture index was built based on a mechanical description of the fracture occurrence under a side fall impact. Results: The current approach predicts with a very good accuracy the fracture risk (TPR = 78%, TNR = 81%) and provided a good agreement with the experimental data, while the DXA-based BMD was less accurate (TPR = 60%, TNR = 56). Our predicted results showed that the proposed bone fracture index, may provide an enhanced diagnostic of proximal fracture risk diagnostic. Conclusions: The index developed here may be used in clinical applications as an enhanced tool to predict fracture risk and contribute to osteoporosis diagnosis based on DXA.

KEYWORDS:

• Hip
• osteoporosis
• fracture
• DXA images
• prediction
• indexes

Acknowledgments

The authors acknowledge the financial support provided by the Fondation pour la Recherche Médicale (FRM) (Project: DIC20161236439).

Disclosure statement

The authors have no conflict of interest to declare.

Ethical approval

The use of medical images in this study was approved by the University of Orléans, France.

Additional information

Notes on contributors

Said Zellagui

Saïd Zellagui  has completed a master’s degree in Mechanics Engineering at University of Le Havre France in 2016. He  is currently the last year PhD student at the LaMé laboratory specified in biomechanics and finite element analysis. He is also concerned about image processing and deep learning. Saïd’s main research during his thesis is to develop a new assessment tool to diagnosis osteoporosis. His current scientific project is going on and has been presented at several national conferences (France, Irland and Turkey) and has been  receiving a lot of attention. 

Audrey Hivet

Audrey Hivet is Senior Lecturer at the University of Orleans. She studiedmaterial structure at ESTACA (Engineering school for aeronautic technics andautomotive construction) and received her PhD degree in 2013 from INSA Lyon(National Institute of Applied Sciences). Since then, she has been working at the University of Orleans as a teacher researcher. Dr Hivet is a member of laboratoire LaMé and her research activities concern mechanics of heterogeneous materials and more precisely fibrous materials. Her research focuses on numerical simulation, modeling fabrics (development and creation of tools in order to create geometrical models and mesh), and characterization and identification of behavior law for dry woven fabrics of composite and biomechanics

Marouane El Mouss

Marouane EL Mouss received his mechanical engineering degree in 2016 after a double education background at ENSAM-Meknès (Morocco) and Polytech-Orléans (France). He obtained his Ph.D. degree at the Mechanical Laboratory Gabriel LaMé (Orléans, France). Currently, he is a Post-Doctoral Researcher at the Institute of computing and data sciences (ISCD) at Sorbonne Université (Paris, France). His research interests include biomechanics and modeling in mechanobiology using the finite element method.

Ridha Hambli

Ridha Hambli is currently a Professor of Biomechanics and the Director of the Research group of Biomechanics and mechanobiology of bone at LaMé Lab in Orleans University in France. He studied Mechanical engineering at Ecole Centrale de Nantes in France and he received his doctoral degree in 1996 from Ecole National Superieur des Arts et Metiers of Angers, France. Subsequently, he worked as a project manager in Ecole National Superieur des Arts et Metiers for two years and then as associate professor at Institut des Sciences et Techniques d'Angers - France. In 2006, he moved to University of Orleans as a full professor where he was involved in teaching and research activities related to biomechanics and mechanobiology of bone. He is an author of about 180 refereed publications and abstracts in international scientific journals and conferences proceedings. He organized several research events and symposiums in relation with his research activities and he acts as a reviewer in several international journals. He also acts as reviewer expert for several organizations in the field of biomechanics. Prof Hambli’s main research activities lie in the finite element multiscale modeling of the human bone behavior considering the remodeling process and the fracture. The scales range from the ultrastructure to the whole bone organ. His recent research focuses on the development of mechanobiological modeling algorithms considering explicitly the effects of the bone cells activities on the bone adaptation process and the associated risk of fracture under side fall. The approach is used to investigate the effect of some bone drugs on the bone quality for a given patient.