Cluster Analysis of Finite Element Analysis and Bone Microarchitectural Parameters Identifies Phenotypes with High Fracture Risk.

Calcif Tissue Int 2019 Sep 11;105(3):252-262. Epub 2019 Jun 11.

MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.

High-resolution peripheral quantitative computed tomography (HRpQCT) is increasingly used for exploring associations between bone microarchitectural and finite element analysis (FEA) parameters and fracture. We hypothesised that combining bone microarchitectural parameters, geometry, BMD and FEA estimates of bone strength from HRpQCT may improve discrimination of fragility fractures. The analysis sample comprised of 359 participants (aged 72-81 years) from the Hertfordshire Cohort Study. Fracture history was determined by self-report and vertebral fracture assessment. Participants underwent HRpQCT scans of the distal radius and DXA scans of the proximal femur and lateral spine. Poisson regression with robust variance estimation was used to derive relative risks for the relationship between individual bone microarchitectural and FEA parameters and previous fracture. Cluster analysis of these parameters was then performed to identify phenotypes associated with fracture prevalence. Receiver operating characteristic analysis suggested that bone microarchitectural parameters improved fracture discrimination compared to aBMD alone, whereas further inclusion of FEA parameters resulted in minimal improvements. Cluster analysis (k-means) identified four clusters. The first had lower Young modulus, cortical thickness, cortical volumetric density and Von Mises stresses compared to the wider sample; fracture rates were only significantly greater among women (relative risk [95%CI] compared to lowest risk cluster: 2.55 [1.28, 5.07], p = 0.008). The second cluster in women had greater trabecular separation, lower trabecular volumetric density and lower trabecular load with an increase in fracture rate compared to lowest risk cluster (1.93 [0.98, 3.78], p = 0.057). These findings may help inform intervention strategies for the prevention and management of osteoporosis.

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http://dx.doi.org/10.1007/s00223-019-00564-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694037PMC
September 2019
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References

(Supplied by CrossRef)

D Marshall et al.
BMJ 1996

SA Wainwright et al.
J Clin Endocrinol Metab 2005

JA Kanis et al.
Osteoporos Int 2007

X Jiang et al.
Bone 2017

N Vilayphiou et al.
J Bone Miner Res 2011

N Vilayphiou et al.
Bone 2010

HA Fink et al.
Bone 2018

E Sornay-Rendu et al.
J Bone Miner Res 2007

E Sornay-Rendu et al.
J Bone Miner Res 2017

P Szulc et al.
J Bone Miner Res 2011

S Boutroy et al.
J Bone Miner Res 2016

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