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Comparison of femur stiffness measured from DXA and QCT for assessment of hip fracture risk

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Abstract

Femur stiffness, for example axial and bending stiffness, integrates both geometric and material information of the bone, and thus can be an effective indicator of bone strength and hip fracture risk. Femur stiffness is ideally measured from quantitative computed tomography (QCT), but QCT is not recommended for routine clinical use due to the public concern about exposure to high-dosage radiation. Dual energy X-ray absorptiometry (DXA) is currently the primary imaging modality in clinic. However, DXA is two-dimensional and it is not clear whether DXA-estimated stiffness has adequate accuracy to replace its QCT counterpart for clinical application. This study investigated the accuracy of femur stiffness (axial and bending) estimated from CTXA (computed tomography X-ray absorptiometry) and DXA against those directly measured from QCT. Proximal-femur QCT and DXA from 67 subjects were acquired. For each femur, the QCT dataset was projected into CTXA using CTXA-Hip (Mindways Software, Inc., USA). Femur stiffness at the femoral neck and intertrochanter were then calculated from QCT, CTXA and DXA, respectively, and different elasticity-density relationships were considered in the calculation. Pearson correlations between QCT and CTXA/DXA measured stiffness were studied. The results showed that there were strong correlations between QCT and CTXA derived stiffness, although the correlations were affected by the adopted elasticity-density relationship. Correlations between QCT and DXA derived stiffness were much less strong, mainly caused by the inconsistence of femur orientation in QCT projection and in DXA positioning. Our preliminary clinical study showed that femur stiffness had slightly better performance than femur geometry in discrimination of hip fracture cases from controls.

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Article Open access 01 July 2023

Enisa Shevroja, Jean-Yves Reginster, … Nicholas C. Harvey

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Acknowledgements

The reported research has been supported by the Natural Sciences and Engineering Research Council (NSERC) and the Manitoba Health Research Council (MHRC) in Canada, which are gratefully acknowledged. Thanks to Winnipeg Health Science Centre for providing the QCT and DXA images used in this study.

Funding

Funding was provided by Natural Sciences and Engineering Research Council of Canada (Grant no: 37098) and Research Manitoba (Grant no: 37807).

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Authors and Affiliations

  1. Department of Mechanical Engineering, University of Manitoba, 75A Chancellor’s Circle, Winnipeg, MB, R3T 2N2, Canada

    Yunhua Luo & Huijuan Yang

  2. Department of Biomedical Engineering, University of Manitoba, 75A Chancellor’s Circle, Winnipeg, MB, R3T 2N2, Canada

    Yunhua Luo

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  1. Yunhua Luo
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  2. Huijuan Yang
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Correspondence to Yunhua Luo.

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Ethical approval

The use of medical images in this study was approved by the Research Ethics Committee at the University of Manitoba, Canada.

Conflict of interest

None of the authors had any personal or financial conflicts of interest.

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Luo, Y., Yang, H. Comparison of femur stiffness measured from DXA and QCT for assessment of hip fracture risk. J Bone Miner Metab 37, 342–350 (2019). https://doi.org/10.1007/s00774-018-0926-z

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  • DOI: https://doi.org/10.1007/s00774-018-0926-z

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