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Prediction of incident vertebral fracture using CT-based finite element analysis

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Abstract

Summary

Prior studies show vertebral strength from computed tomography-based finite element analysis may be associated with vertebral fracture risk. We found vertebral strength had a strong association with new vertebral fractures, suggesting that vertebral strength measures identify those at risk for vertebral fracture and may be a useful clinical tool.

Introduction

We aimed to determine the association between vertebral strength by quantitative computed tomography (CT)-based finite element analysis (FEA) and incident vertebral fracture (VF). In addition, we examined sensitivity and specificity of previously proposed diagnostic thresholds for fragile bone strength and low BMD in predicting VF.

Methods

In a case-control study, 26 incident VF cases (13 men, 13 women) and 62 age- and sex-matched controls aged 50 to 85 years were selected from the Framingham multi-detector computed tomography cohort. Vertebral compressive strength, integral vBMD, trabecular vBMD, CT-based BMC, and CT-based aBMD were measured from CT scans of the lumbar spine.

Results

Lower vertebral strength at baseline was associated with an increased risk of new or worsening VF after adjusting for age, BMI, and prevalent VF status (odds ratio (OR) = 5.2 per 1 SD decrease, 95% CI 1.3–19.8). Area under receiver operating characteristic (ROC) curve comparisons revealed that vertebral strength better predicted incident VF than CT-based aBMD (AUC = 0.804 vs. 0.715, p = 0.05) but was not better than integral vBMD (AUC = 0.815) or CT-based BMC (AUC = 0.794). Additionally, proposed fragile bone strength thresholds trended toward better sensitivity for identifying VF than that of aBMD-classified osteoporosis (0.46 vs. 0.23, p = 0.09).

Conclusion

This study shows an association between vertebral strength measures and incident vertebral fracture in men and women. Though limited by a small sample size, our findings also suggest that bone strength estimates by CT-based FEA provide equivalent or better ability to predict incident vertebral fracture compared to CT-based aBMD. Our study confirms that CT-based estimates of vertebral strength from FEA are useful for identifying patients who are at high risk for vertebral fracture.

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References

  1. Melton LJ, Lane AW, Cooper C et al (1993) Prevalence and incidence of vertebral deformities. Osteoporos Int 3:113–119. https://doi.org/10.1007/BF01623271

    Article  PubMed  Google Scholar 

  2. Schuit SCE, Van Der Klift M, Weel AEAM et al (2004) Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam study. Bone 34:195–202. https://doi.org/10.1016/j.bone.2003.10.001

    Article  CAS  PubMed  Google Scholar 

  3. Cosman F, Krege JH, Looker AC, Schousboe JT, Fan B, Sarafrazi Isfahani N, Shepherd JA, Krohn KD, Steiger P, Wilson KE, Genant HK (2017) Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. Osteoporos Int 28:1857–1866. https://doi.org/10.1007/s00198-017-3948-9

    Article  CAS  PubMed  Google Scholar 

  4. Schneider EL, Guralnik JM (1990) The aging of America. JAMA 263:2335–2340. https://doi.org/10.1001/jama.1990.03440170057036

    Article  CAS  PubMed  Google Scholar 

  5. Gillespie CW, Morin PE (2017) Trends and disparities in osteoporosis screening among women in the United States, 2008-2014. Am J Med 130:306–316. https://doi.org/10.1016/j.amjmed.2016.10.018

    Article  PubMed  Google Scholar 

  6. Binkley N, Blank RD, Leslie WD, Lewiecki EM, Eisman JA, Bilezikian JP (2017) Osteoporosis in crisis: it’s time to focus on fracture. J Bone Miner Res 32:1391–1394. https://doi.org/10.1002/jbmr.3182

    Article  PubMed  Google Scholar 

  7. Orwoll ES, Marshall LM, Nielson CM, Cummings SR, Lapidus J, Cauley JA, Ensrud K, Lane N, Hoffmann PR, Kopperdahl DL, Keaveny TM, for the Osteoporotic Fractures in Men (MrOS) Study Group (2009) Finite element analysis of the proximal femur and hip fracture risk in older men. J Bone Miner Res 2424:475–483. https://doi.org/10.1359/JBMR.081201

    Article  Google Scholar 

  8. Ward J, Wood C, Rouch K, Pienkowski D, Malluche HH (2016) Stiffness and strength of bone in osteoporotic patients treated with varying durations of oral bisphosphonates. Osteoporos Int 27:2681–2688. https://doi.org/10.1007/s00198-016-3661-0

    Article  CAS  PubMed  Google Scholar 

  9. Crawford RP, Cann CE, Keaveny TM (2003) Finite element models predict in vitro vertebral body compressive strength better than quantitative computed tomography. Bone 33:744–750. https://doi.org/10.1016/S8756-3282(03)00210-2

    Article  PubMed  Google Scholar 

  10. Imai K, Ohnishi I, Bessho M, Nakamura K (2006) Nonlinear finite element model predicts vertebral bone strength and fracture site. Spine (Phila Pa 1976) 31:1789–1794. https://doi.org/10.1097/01.brs.0000225993.57349.df

    Article  Google Scholar 

  11. Zysset PK, Dall’Ara E, Varga P, Pahr DH (2013) Finite element analysis for prediction of bone strength. Bonekey Rep 2:1–9. https://doi.org/10.1038/bonekey.2013.120

    Article  Google Scholar 

  12. Wang X, Sanyal A, Cawthon PM, Palermo L, Jekir M, Christensen J, Ensrud KE, Cummings SR, Orwoll E, Black DM, for the Osteoporotic Fractures in Men (MrOS) Research Group, Keaveny TM (2012) Prediction of new clinical vertebral fractures in elderly men using finite element analysis of CT scans. J Bone Miner Res 27:808–816. https://doi.org/10.1002/jbmr.1539

    Article  PubMed  PubMed Central  Google Scholar 

  13. Graeff C, Marin F, Petto H, Kayser O, Reisinger A, Peña J, Zysset P, Glüer CC (2013) High resolution quantitative computed tomography-based assessment of trabecular microstructure and strength estimates by finite-element analysis of the spine, but not DXA, reflects vertebral fracture status in men with glucocorticoid-induced osteoporosis. Bone 52:568–577. https://doi.org/10.1016/j.bone.2012.10.036

    Article  CAS  PubMed  Google Scholar 

  14. Melton LJ, Riggs BL, Keaveny TM et al (2010) Relation of vertebral deformities to bone density, structure, and strength. J Bone Miner Res 25:1922–1930. https://doi.org/10.1002/jbmr.150

    Article  PubMed  PubMed Central  Google Scholar 

  15. Imai K, Ohnishi I, Matsumoto T, Yamamoto S, Nakamura K (2009) Assessment of vertebral fracture risk and therapeutic effects of alendronate in postmenopausal women using a quantitative computed tomography-based nonlinear finite element method. Osteoporos Int 20:801–810. https://doi.org/10.1007/s00198-008-0750-8

    Article  CAS  PubMed  Google Scholar 

  16. Melton LJ, Riggs BL, Keaveny TM et al (2007) Structural determinants of vertebral fracture risk. J Bone Miner Res 22:1885–1892. https://doi.org/10.1359/jbmr.070728

    Article  PubMed  Google Scholar 

  17. Kopperdahl DL, Aspelund T, Hoffmann PF, Sigurdsson S, Siggeirsdottir K, Harris TB, Gudnason V, Keaveny TM (2014) Assessment of incident spine and hip fractures in women and men using finite element analysis of CT scans. J Bone Miner Res 29:570–580. https://doi.org/10.1002/jbmr.2069

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hoffmann U, Massaro JM, Fox CS, Manders E, O'Donnell CJ (2008) Defining normal distributions of coronary artery calcium in women and men from the Framingham heart study. Am J Cardiol 102:1136–1141. https://doi.org/10.1016/j.amjcard.2008.06.038.Defining

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Feinleib M, Kannel WB, Garrison RJ et al (1975) The Framingham offspring study. Design and preliminary data. Prev Med (Baltim) 4:518–525. https://doi.org/10.1016/0091-7435(75)90035-3

    Article  CAS  Google Scholar 

  20. Splansky GL, Corey D, Yang Q, Atwood LD, Cupples LA, Benjamin EJ, D'Agostino RB, Fox CS, Larson MG, Murabito JM, O'Donnell CJ, Vasan RS, Wolf PA, Levy D (2007) The third generation cohort of the National Heart, Lung, and Blood Institute’s Framingham heart study: design, recruitment, and initial examination. Am J Epidemiol 165:1328–1335. https://doi.org/10.1093/aje/kwm021

    Article  PubMed  Google Scholar 

  21. Dawber TR, Meadors GF, Moore FE (1951) Epidemiological approaches to heart disease: the Framingham study. Am J Public Health 41:279–281. https://doi.org/10.2105/AJPH.41.3.279

    Article  CAS  Google Scholar 

  22. Chan JJ, Cupples LA, Kiel DP, O'Donnell CJ, Hoffmann U, Samelson EJ (2015) QCT volumetric bone mineral density and vascular and valvular calcification: the Framingham study. J Bone Miner Res 30:1767–1774. https://doi.org/10.1002/jbmr.2530

    Article  PubMed  PubMed Central  Google Scholar 

  23. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148. https://doi.org/10.1002/jbmr.5650080915

    Article  CAS  PubMed  Google Scholar 

  24. Yau MS, Demissie S, Zhou Y, Anderson DE, Lorbergs AL, Kiel DP, Allaire BT, Yang L, Cupples LA, Travison TG, Bouxsein ML, Karasik D, Samelson EJ (2016) Heritability of thoracic spine curvature and genetic correlations with other spine traits: the Framingham study. J Bone Miner Res 31:2077–2084. https://doi.org/10.1002/jbmr.2925

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Keaveny TM, Donley DW, Hoffmann PF, Mitlak BH, Glass EV, San Martin JA (2007) Effects of teriparatide and alendronate on vertebral strength as assessed by finite element modeling of QCT scans in women with osteoporosis. J Bone Miner Res 22:149–157. https://doi.org/10.1359/jbmr.061011

    Article  CAS  PubMed  Google Scholar 

  26. Morgan EF, Keaveny TM (2001) Dependence of yield strain of human trabecular bone on anatomic site. J Biomech 34:569–577. https://doi.org/10.1016/S0021-9290(01)00011-2

    Article  CAS  PubMed  Google Scholar 

  27. Morgan EF, Bayraktar HH, Keaveny TM (2003) Trabecular bone modulus-density relationships depend on anatomic site. J Biomech 36:897–904. https://doi.org/10.1016/S0021-9290(03)00071-X

    Article  PubMed  Google Scholar 

  28. Kopperdahl DL, Morgan EF, Keaveny TM (2002) Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone. J Orthop Res 20:801–805

    Article  PubMed  Google Scholar 

  29. Engelke K, Adams JE, Armbrecht G, Augat P, Bogado CE, Bouxsein ML, Felsenberg D, Ito M, Prevrhal S, Hans DB, Lewiecki EM (2008) Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD official positions. J Clin Densitom 11:123–162. https://doi.org/10.1016/j.jocd.2007.12.010

    Article  PubMed  Google Scholar 

  30. Schousboe JT, Shepherd JA, Bilezikian JP, Baim S (2013) Executive summary of the 2013 International Society for Clinical Densitometry Position Development Conference on bone densitometry. J Clin Densitom 16:455–466. https://doi.org/10.1016/j.jocd.2013.08.004

    Article  PubMed  Google Scholar 

  31. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ III, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42:467–475

    Article  CAS  PubMed  Google Scholar 

  32. Altman DG, Bland JM (1994) Diagnostic tests. 1: sensitivity and specificity. BMJ 308:1552. https://doi.org/10.1136/bmj.308.6943.1552

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Keyak JH, Rossi SA, Jones KA, Skinner HB (1997) Prediction of femoral fracture load using automated finite element modelling. J Biomech 31:125–133. https://doi.org/10.1016/S0021-9290(97)00123-1

    Article  Google Scholar 

  34. van Rietbergen B, Weinans H, Huiskes R, Odgaard A (1995) A new method to determine trabecular bone elastic properties and loading using micromechanical finite-elements models. J Biomech 28:69–81

    Article  PubMed  Google Scholar 

  35. Keyak JH, Sigurdsson S, Karlsdottir G, Oskarsdottir D, Sigmarsdottir A, Zhao S, Kornak J, Harris TB, Sigurdsson G, Jonsson BY, Siggeirsdottir K, Eiriksdottir G, Gudnason V, Lang TF (2011) Male-female differences in the association between incident hip fracture and proximal femur strength: a finite element analysis study. Bone 48:1239–1245. https://doi.org/10.1016/j.bone.2011.03.682.Male-female

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323. https://doi.org/10.1001/jama.285.3.320

    Article  CAS  PubMed  Google Scholar 

  37. Weber NK, Fidler JL, Keaveny TM, Clarke BL, Khosla S, Fletcher JG, Lee DC, Pardi DS, Loftus EV, Kane SV, Barlow JM, Murthy NS, Becker BD, Bruining DH (2014) Validation of a CT-derived method for osteoporosis screening in IBD patients undergoing contrast-enhanced CT enterography. Am J Gastroenterol 109:401–408. https://doi.org/10.1038/ajg.2013.478

    Article  PubMed  PubMed Central  Google Scholar 

  38. Fidler JL, Murthy NS, Khosla S, Clarke BL, Bruining DH, Kopperdahl DL, Lee DC, Keaveny TM (2016) Comprehensive assessment of osteoporosis and bone fragility with CT colonography. Radiology 278:172–180. https://doi.org/10.1148/radiol.2015141984

    Article  PubMed  Google Scholar 

  39. Lee DC, Hoffmann PF, Kopperdahl DL, Keaveny TM (2017) Phantomless calibration of CT scans for measurement of BMD and bone strength—inter-operator reanalysis precision. Bone 103:325–333. https://doi.org/10.1016/j.bone.2017.07.029

    Article  PubMed  PubMed Central  Google Scholar 

  40. Adams A, Fischer H, Kopperdahl D et al (2017) The fracture, osteoporosis, and CT utilization study (FOCUS)—utilizing pre-existing CT to assess risk of hip fracture in a large real-world clinical setting. J Bone Miner Res 32(Suppl):1

    Google Scholar 

  41. Agten CA, Ramme AJ, Kang S, Honig S, Chang G (2017) Cost-effectiveness of virtual bone strength testing in osteoporosis screening programs for postmenopausal women in the United States. Radiology 161259:506–517. https://doi.org/10.1148/radiol.2017161259

    Article  Google Scholar 

  42. Anderson DE, Demissie S, Allaire BT, Bruno AG, Kopperdahl DL, Keaveny TM, Kiel DP, Bouxsein ML (2014) The associations between QCT-based vertebral bone measurements and prevalent vertebral fractures depend on the spinal locations of both bone measurement and fracture. Osteoporos Int 25:559–566. https://doi.org/10.1007/s00198-013-2452-0

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The contents are solely the responsibility of the authors and do not necessarily represent the views of the NIH. We acknowledge Dr. Harry K. Genant’s contribution in reviewing vertebral fracture assessment.

Funding

This work was supported by grants from the National Institutes of Health (R01 AR053986, R00 AG042458, R01 AG041658, R01 AR041398), and by the National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study (NIH/NHLBI Contract N01-HC-25195).

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Correspondence to M. L. Bouxsein.

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Brett T. Allaire, Darlene Lu, Fjola Johannesdottir, Mohamed Jarraya, Ali Guermazi, Miriam A. Bredella, Elizabeth J. Samelson, Douglas P. Kiel, Dennis E.Anderson, Serkalem Demissie, and Mary L. Bouxsein declare that they have no conflicts of interest. Dr. Keaveny has been a consultant for Amgen, AgNovos Healthcare, and O.N. Diagnostics and has equity in O.N. Diagnostics. Drs. Keaveny and Kopperdahl have financial interests in O.N. Diagnostics and both they and the company may benefit from the results of this work.

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Allaire, B.T., Lu, D., Johannesdottir, F. et al. Prediction of incident vertebral fracture using CT-based finite element analysis. Osteoporos Int 30, 323–331 (2019). https://doi.org/10.1007/s00198-018-4716-1

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