3D Analysis of the Proximal Femur Compared to 2D Analysis for Hip Fracture Risk Prediction in a Clinical Population
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Annals of Biomedical Engineering ( 2020) https://doi.org/10.1007/s10439-020-02670-2
Original Article
3D Analysis of the Proximal Femur Compared to 2D Analysis for Hip Fracture Risk Prediction in a Clinical Population FATEMEH JAZINIZADEH1 and CHERYL E. QUENNEVILLE1,2 1
Department of Mechanical Engineering, McMaster University, ABB-C308, 1280 Main St. West, Hamilton, ON L8S 4L8, Canada; and 2School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada (Received 20 July 2020; accepted 20 October 2020) Associate Editor Lyndia (Chun) Wu oversaw the review of this article.
Abstract—Due to the adverse impacts of hip fractures on patients’ lives, it is crucial to enhance the identification of people at high risk through accessible clinical techniques. Reconstructing the 3D geometry and BMD distribution of the proximal femur could be beneficial in enhancing hip fracture risk predictions; however, it is associated with a high computational burden. It is also not clear whether it provides a better performance than 2D model analysis. Therefore, the purpose of this study was to compare the 2D and 3D model reconstruction’s ability to predict hip fracture risk in a clinical population of patients. The DXA scans and CT scans of 16 cadaveric femurs were used to create training sets for the 2D and 3D model reconstruction based on statistical shape and appearance modeling. Subsequently, these methods were used to predict the risk of sustaining a hip fracture in a clinical population of 150 subjects (50 fractured, and 100 non-fractured) that were monitored for five years in the Canadian Multicentre Osteoporosis Study. 3D model reconstruction was able to improve the identification of patients who sustained a hip fracture more accurately than the standard clinical practice (by 40%). Also, the predictions from the 2D statistical model didn’t differ significantly from the 3D ones (p > 0.76). These results indicated that to enhance hip fracture risk prediction in clinical practice implementing 2D statistical modeling has comparable performance with lower associated computational load. Keywords—Hip fracture risk, Proximal femur, DXA scanning, 2D statistical modeling, 3D statistical modeling.
Address correspondence to Cheryl E. Quenneville, Department of Mechanical Engineering, McMaster University, ABB-C308, 1280 Main St. West, Hamilton, ON L8S 4L8, Canada. Electronic mail: [email protected]
INTRODUCTION Osteoporosis is a disease most common in older adults, which results in low bone mass and micro-architectural deterioration, and can lead to a bone fracture.31 The hip (proximal femur) is one of the most common sites affected by osteoporosis, the fracture of which can result in severe morbidity and mortality.12,27 Patients with an early diagnosis of osteoporosis can benefit from protective measures (e.g., targeted exercise, hip protectors, pharmaceutical interventions) to prevent these fractures.25,39 Currently, the most common method for the diagnosis of osteoporosis relies on the measurement of bone mineral density (BMD)
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