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Association between osteoporotic femoral neck fractures and DXA-derived 3D measurements at lumbar spine: a case-control study

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Abstract

Summary

A case-control study assessing the association of DXA-derived 3D measurements at lumbar spine with osteoporotic hip fractures was performed. Stronger association was found between transcervical hip fractures and integral (AUC = 0.726), and cortical (AUC = 0.696) measurements at the lumbar spine compared with measurements at the trabecular bone (AUC = 0.617); although femur areal bone mineral density (aBMD) remains the referent measurement for hip fracture risk evaluation (AUC = 0.838).

Purpose

The aim of the present study was to evaluate the association between DXA-derived 3D measurements at lumbar spine and osteoporotic hip fractures.

Methods

We analyzed a case-control database composed by 61 women with transcervical hip fractures and 61 age-matched women without any type of fracture. DXA scans at lumbar spine were acquired, and areal bone mineral density (aBMD) was measured. Integral, trabecular and cortical volumetric BMD (vBMD), cortical thickness, and cortical surface BMD (sBMD) at different regions of interest were assessed using a DXA-based 3D modeling software. Descriptive statistics, tests of difference, odds ratio (OR), and area under the receiver operating curve (AUC) were used to compare hip fracture and control groups.

Results

Integral vBMD, cortical vBMD, cortical sBMD, and cortical thickness were the DXA-derived 3D measurements at lumbar spine that showed the stronger association with transcervical hip fractures, with AUCs in the range of 0.685–0.726, against 0.670 for aBMD. The highest AUC (0.726) and OR (2.610) at the lumbar spine were found for integral vBMD at the posterior vertebral elements. Significantly, lower AUC (0.617) and OR (1.607) were found for trabecular vBMD at the vertebral body. Overall, total femur aBMD remains the DXA-derived measurement showing the highest AUC (0.838) and OR (6.240).

Conclusion

This study showed the association of DXA-derived measurements at lumbar spine with transcervical hip fractures. A strong association between vBMD at the posterior vertebral elements and transcervical hip fractures was observed, probably because of global deterioration of the cortical bone. Further studies should be carried out to investigate on the relative risk of transcervical fracture in patients with long-term cortical structural deterioration.

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Acknowledgments

We would like to acknowledge the support from the Industrial Doctorates program of the Generalitat de Catalunya, as well as the QUAES Foundation - UPF Chair for Computational Tools for Healthcare.

Funding

The research leading to these results has also received funding from: Programa Estatal de Investigación, Desarrollo e Innovación Orientada a los Retos de la Sociedad, Ministerio de Economía y Competitividad (Reference: RTC-2014-2740-1), and Eurostars program (Project ID: 9 140) funded by Centro para el Desarrollo Tecnológico Industrial, Ministerio de Economía Competitividad.

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Authors and Affiliations

  1. Musculoskeletal Unit, Galgo Medical, Barcelona, Spain

    Mirella López Picazo, Ludovic Humbert & Renaud Winzenrieth

  2. BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain

    Mirella López Picazo & Miguel A. González Ballester

  3. CETIR Grup Mèdic, Barcelona, Spain

    Silvana Di Gregorio & Luis M. del Río Barquero

  4. ICREA, Barcelona, Spain

    Miguel A. González Ballester

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Correspondence to Mirella López Picazo.

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M. López Picazo and R. Winzenrieth are employees of Galgo Medical. L. Humbert is a stockholder and an employee of Galgo Medical. S. Di Gregorio, M. A. González Ballester, and L. Del Rio have no conflict of interest.

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López Picazo, M., Humbert, L., Winzenrieth, R. et al. Association between osteoporotic femoral neck fractures and DXA-derived 3D measurements at lumbar spine: a case-control study. Arch Osteoporos 15, 8 (2020). https://doi.org/10.1007/s11657-019-0680-4

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