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Lekadir et al. Predicting the risk of low impact fractures—a new statistical model

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DOI:10.1038/bonekey.2016.7

Predicting the risk of low impact fractures would be of benefit to patients and would reduce the demand on healthcare resources. To date, however, it has proved difficult to generate accurate models based on in vivo imaging. Previously developed isotropic models do not accurately reflect stress states within trabecular bone, which is anisotropic in nature.

Here, Lekadir et al. report the development and testing of a statistical method for estimating bone strength. This has the distinct advantage that it can be used to determine fracture risk in individual patients based on standard QCT images obtained in clinical practice. The statistical model used, which was specific for the microarchitecture of trabecular bone, was derived from a sample of ex vivo micro-CT datasets and then used within a biomechanical simulation workflow.

The authors applied it to estimate the fracture load of patients at the T12 vertebra and the femur within two different databases. They show that the estimates obtained from the statistical model were in close agreement with the estimates based on micro-CT data, with concordance coefficients of 98.6% for the femur and 95.5% for the T12 vertebra.

Editor’s comment: The authors report their successful application of an alternative statistical approach to predict the principal orientations and degree of anisotropy of trabecular bone. This finding sets a new standard in mapping of material properties in finite element analysis (FEA) of bones from clinical QCT images.

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