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Predicting fracture risk using nonlinear micro-finite element simulations

DOI:10.1038/bonekey.2014.29

Christen et al. used nonlinear micro-finite element (μFE) simulations to study bone parameters in 100 menopausal women with a distal forearm fracture, comparing them with matched controls to determine whether these simulations could be used to predict fracture risk.

The findings from μFE simulations were also compared with data from high-resolution peripheral quantitative CT data from a previous study. The odds ratio (OR) for the factor-of-risk (OR=1.99; 95% CI, 1.41–2.77), defined as yield load/predicted fall load, was slightly greater than the value derived from linear μFE simulations. Yield deformation (bone ductility) was a good independent predictive factor for fracture risk but the separation of cases improved by a third when yield deformation was combined with yield load-based factor-of-risk (a measure of relative bone strength) and cortical plastic volume (an indicator of how the structure of bone resists critical loading).

Editor’s comment: This is the first study to apply a pQCT-based nonlinear micro-finite element method in clinical practice to estimate radial strength in postmenopausal women who have suffered a distal forearm fracture. Strength shows an impressively high correlation with stiffness and improves the odds ratio for fracture risk prediction. The computing resources and time for this type of analysis remain an important consideration.

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