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首页> 美国卫生研究院文献>Journal of Bone and Mineral Research >Improved fracture risk assessment based on nonlinear micro-finite element simulations from HRpQCT images at the distal radius
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Improved fracture risk assessment based on nonlinear micro-finite element simulations from HRpQCT images at the distal radius

机译：基于远端radius骨HRpQCT图像的非线性微有限元模拟改善了骨折风险评估

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More accurate techniques to estimate fracture risk could help reduce the burden of fractures in postmenopausal women. Although micro-finite element (µFE) simulations allow a direct assessment of bone mechanical performance, in this first clinical study, we investigated whether the additional information obtained using geometrically and materially nonlinear µFE simulations allows a better discrimination between fracture cases and controls. We used patient data and high-resolution peripheral quantitative computed tomography (HRpQCT) measurements from our previous clinical study on fracture risk which compared 100 postmenopausal women with a distal forearm fracture to 105 controls. Analyzing these data with the nonlinear µFE simulations, the odds ratio (OR) for the factor-of-risk (yield load divided by the expected fall load) was marginally higher (1.99; 95% CI, 1.41–2.77) than for the factor-of-risk computed from linear µFE (1.89; 95% CI, 1.37–2.69). The yield load and the energy absorbed up to the yield point as computed from nonlinear µFE were highly correlated with the initial stiffness (R2, 0.97 and 0.94, respectively) and could therefore be derived from linear simulations with little loss in precision. However, yield deformation was not related to any other measurement performed and was itself a good predictor of fracture risk (OR, 1.89; 95% CI, 1.39–2.63). Moreover, a combined risk score integrating information on relative bone strength (yield load-based factor-of-risk), bone ductility (yield deformation) and the structural integrity of the bone under critical loads (cortical plastic volume) improved the separation of cases and controls by one third (OR, 2.66; 95% CI, 1.84–4.02). We therefore conclude that nonlinear µFE simulations provide important additional information on the risk of distal forearm fractures not accessible from linear µFE nor from other techniques assessing bone microstructure, density or mass.
机译：评估骨折风险的更准确技术可以帮助减轻绝经后妇女的骨折负担。尽管微有限元（µFE）模拟可以直接评估骨骼的力学性能，但在本项首次临床研究中，我们调查了使用几何和材料非线性µFE模拟获得的其他信息是否可以更好地区分骨折病例和对照。我们使用患者数据和我们之前关于骨折风险的临床研究的高分辨率外周定量计算机断层扫描（HRpQCT）测量，该研究将100例绝经后女性伴有前臂远端骨折与105例对照进行了比较。用非线性µFE仿真分析这些数据，风险因子的比值比（OR）（屈服载荷除以预期的跌落载荷）比该因子略高（1.99; 95％CI，1.41–2.77）风险由线性µFE（1.89; 95％CI，1.37–2.69）计算得出。由非线性µFE计算得出的屈服载荷和吸收到屈服点的能量与初始刚度高度相关（分别为R 2 ，0.97和0.94），因此可以从线性仿真得出：精度损失很小。但是，屈服变形与进行的任何其他测量均无关，它本身是断裂风险的良好预测指标（OR，1.89； 95％CI，1.39–2.63）。此外，结合了有关相对骨强度（基于屈服载荷的危险因素），骨延展性（屈服变形）和在关键载荷（皮质塑料体积）下骨骼的结构完整性的信息的组合风险评分改善了病例分离并控制三分之一（OR为2.66； 95％CI为1.84-4.02）。因此，我们得出的结论是，非线性µFE模拟提供了重要的附加信息，说明线性µFE或其他评估骨微结构，密度或质量的技术无法获得的远端前臂骨折风险。

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