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Association of 3D Geometric Measures Derived From Quantitative Computed Tomography With Hip Fracture Risk in Older
Jan Borggrefe1,2, Timm de Buhr1, Smriti Shrestha3
1Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
Insights
Quantitative computed tomography (QCT) measures of the proximal femur, including 3D geometry and volumetric bone mineral density (vBMD), predict hip fracture risk in elderly men. These QCT measures offer insights beyond dual-energy X-ray absorptiometry (DXA) for fracture prediction.
Area of Science:
- Orthopedics and Bone Health
- Radiology and Medical Imaging
- Gerontology
Background:
- Hip fractures are a significant health concern in elderly men, leading to morbidity and mortality.
- Dual-energy X-ray absorptiometry (DXA) is commonly used to assess bone mineral density (BMD), but may not fully capture bone strength.
- Quantitative computed tomography (QCT) offers advanced 3D imaging of bone structure and volumetric BMD (vBMD).
Purpose of the Study:
- To investigate the association between 3D geometric measures and vBMD of the proximal femur, assessed by QCT, and hip fracture risk in elderly men.
- To compare the predictive value of QCT-derived bone strength indices with traditional areal BMD (aBMD) from DXA.
Main Methods:
- Prospective case-cohort study within the Osteoporotic Fractures in Men Study (MrOS) cohort.
- QCT scans of 230 men (65 with hip fractures) were analyzed for femoral neck (FN) and trochanteric region (TR) measures, including minimum section modulus, buckling ratio, local thinning index (LTI), and integral/trabecular vBMD.
- Cox proportional hazard regression models were used to estimate hazard ratios (HR) for incident hip fracture, adjusting for age, BMI, site, and aBMD.
Main Results:
- All QCT measures, except TR_LTI, were significantly associated with hip fracture risk after adjusting for age, BMI, and site.
- DXA total femur aBMD (HR=4.9) and QCT total femur BMD (HR=5.5) showed the strongest associations, followed by QCT FN integral vBMD (HR=3.6).
- In models including aBMD, FN buckling ratio (HR=1.9) and TR trabecular vBMD (HR=2.0) remained independently associated with hip fracture risk.
Conclusions:
- QCT-derived 3D geometric indices of proximal femur instability are significantly associated with incident hip fractures, independent of DXA aBMD.
- Femoral neck buckling represents a failure mode not fully captured by DXA, highlighting the added value of QCT.
- Further research is warranted to explore these associations in women.
Abstract:
We investigated the associations of 3D geometric measures and volumetric bone mineral density (vBMD) of the proximal femur assessed by quantitative computed tomography (QCT) with hip fracture risk among elderly men. This study was a prospective case-cohort design nested within the Osteoporotic Fractures in Men Study (MrOS) cohort. QCT scans of 230 men (65 with confirmed hip fractures) were evaluated with Mindways' QCTPRO-BIT software. Measures that are indicative of bone strength for the femoral neck (FN) and for the trochanteric region (TR) were defined. Bending strength measures were estimated by minimum section modulus, buckling strength by buckling ratio, and a local thinning index (LTI). Integral and trabecular vBMD measures were also derived. Areal BMD (aBMD) of the total proximal femur from dual-energy X-ray absorptiometry (DXA) is presented for comparison. Associations of skeletal measures with incident hip fracture were estimated with hazard ratios (HR) per standard deviation and their 95% confidence intervals (CI) from Cox proportional hazard regression models with adjustment for age, body mass index (BMI), site, and aBMD. Men with hip fractures were older than men without fracture (77.1 ± 6.0 years versus 73.3 ± 5.7 years, p < 0.01). Age, BMI, and site-adjusted HRs were significant for all measures except TR_LTI. Total femural BMD by DXA (HR = 4.9, 95% CI 2.5-9.9) and QCT (HR = 5.5, 95% CI 2.5-11.7) showed the strongest association followed by QCT FN integral vBMD (HR = 3.6, 95% CI 1.8-6.9). In models that additionally included aBMD, FN buckling ratio (HR = 1.9, 95% CI 1.1-3.2) and trabecular vBMD of the TR (HR = 2.0, 95% CI 1.2-3.4) remained associated with hip fracture risk, independent of aBMD. QCT-derived 3D geometric indices of instability of the proximal femur were significantly associated with incident hip fractures, independent of DXA aBMD. Buckling of the FN is a relevant failure mode not entirely captured by DXA. Further research to study these relationships in women is warranted. © 2016 American Society for Bone and Mineral Research.
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