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Cited by 95Bone health and osteoporosis researchSpinal Fractures and Fixation TechniquesMedical Imaging and Analysis

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

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Allaire, B. T., Lu, D., Johannesdottir, F., Kopperdahl, D., Keaveny, T. M., Jarraya, M., Guermazi, A., Bredella, M. A. +5 more·2019·Osteoporosis International
DOI 10.1007/s00198-018-4716-1PMC PMC6450770
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Abstract

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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  • Differences in the study population, focus on prevalent instead of incident fractures, and better sensitivity to detect fractures by using ≤1-mm instead of 2.5-mm axial slices could lead to relatively higher ORs compared to Allaire et al.

    “These differences in the study population—paired with the focus on prevalent instead of incident fractures and better sensitivity to detect fractures by using ≤ 1-mm instead of 2.5-mm axial slices [26]—could lead to the relatively higher ORs compared to Allaire et al (OR = 2.7 vs. 1.6 for CT-based aBMD, OR = 4.8 vs. 2.8 for integral vBMD, and OR = 6.8 vs. 2.1 for trabecular vBMD) [27]; though, CT–”

    From Automatic opportunistic osteoporosis screening in routine CT: improved prediction of patients with prevalent vertebral fractures compared to DXA (2021) · cites this paper as [27]

    The Methods and Results identify Allaire et al.’s study as examining incident vertebral fractures, and the Results report an OR of 1.6 for CT-based aBMD. Our copy says integral and trabecular vBMD were associated with incident fracture, but the passages do not give the specific ORs of 2.8 and 2.1 attributed to Allaire et al. The proposed reasons for the higher ORs are the citing authors’ interpretation; the slice-thickness comparison is attached to a different citation. (LLM, conf=0.82)

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Authors
Allaire, B. T., Lu, D., Johannesdottir, F., Kopperdahl, D., Keaveny, T. M., Jarraya, M., Guermazi, A., Bredella, M. A., Samelson, E. J., Kiel, D. P., Anderson, D. E., Demissie, S., & Bouxsein, M. L.
Affiliations
  • Beth Israel Deaconess Medical Center (US)
  • Boston University (US)
  • O.N. Diagnostics (United States) (US)
  • University of California, Berkeley (US)
  • Massachusetts General Hospital (US)
Corresponding author
Bouxsein, M. L.
ORCID
Venue
Osteoporosis International
Publisher
Springer Science and Business Media LLC
Published
2018-10-10
Volume
30
Issue
2
Pages
323-331
ISSN
  • 0937-941X (ISSN-L)
  • 1433-2965
DOI
10.1007/s00198-018-4716-1
PMC
PMC6450770
OpenAlex
W2895965876
Cited by
95
References
1
Citations by year
2026: 11 · 2025: 8 · 2024: 7 · 2023: 16 · 2022: 19 · 2021: 20 · 2020: 12 · 2019: 2
FWCI
9.26
Type
journal article
Language
en
Open access
Licence
Locations
  • Osteoporosis International (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (R01 AR053986, R00 AG042458, R01 AG041658, R01 AR041398)
  • National Heart, Lung, and Blood Institute (N01-HC-25195)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Surgery › Spinal Fractures and Fixation Techniques
  • Physical Sciences › Engineering › Biomedical Engineering › Medical Imaging and Analysis
Keywords
vertebral fractures, bone strength, osteoporosis, bone mineral density, trabecular bone score, bone mineral content, fracture risk prediction, diagnostic thresholds, lumbar spine
MeSH terms
Aged, Aged, 80 and over, Female, Humans, Lumbar Vertebrae, Male, Middle Aged, Osteoporosis, Predictive Value of Tests, Radiographic Image Interpretation, Computer-Assisted, Sensitivity and Specificity, Tomography, X-Ray Computed, Bone Density, Case-Control Studies, Spinal Fractures, Risk Assessment, Finite Element Analysis, Osteoporotic Fractures

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