Gregory Chang MD, Presenter: Nothing to Disclose

Stephen Honig MD, Abstract Co-Author: Nothing to Disclose

Ryan Brown, Abstract Co-Author: Nothing to Disclose

Cem Murat Deniz, Abstract Co-Author: Nothing to Disclose

Kenneth A. Egol MD, Abstract Co-Author: Nothing to Disclose

James S. Babb PhD, Abstract Co-Author: Nothing to Disclose

Ravinder Regatte PhD, Abstract Co-Author: Nothing to Disclose

Chamith Rajapakse PhD, Abstract Co-Author: Nothing to Disclose

To determine the feasibility of using finite element analysis applied to 3-T magnetic resonance (MR) images of proximal femur microarchitecture to detect lower bone strength in subjects with with fragility fractures compared with controls without fracture.

This prospective study was institutional review board approved and HIPAA compliant. Written informed consent was obtained. Postmenopausal women with (n = 22) and without (n = 22) fragility fractures were matched for age and body mass index. All subjects underwent standard dual-energy x-ray absorptiometry. Images of proximal femur microarchitecture were obtained by using a high-resolution three-dimensional fast low-angle shot sequence at 3 T. Finite element analysis was applied to compute elastic modulus as a measure of strength in the femoral head and neck, Ward's triangle, greater trochanter, and intertrochanteric region. The Mann-Whitney test was used to compare bone mineral density T scores and elastic moduli between the groups. The relationship (R2) between elastic moduli and bone mineral density T scores was assessed.

Patients with fractures showed lower elastic modulus than did control subjects in all proximal femur regions (femoral head, 8.51–8.73 GPa vs 9.32–9.67 GPa; p = 0.04; femoral neck, 3.11–3.72 GPa vs 4.39–4.82 GPa; p = 0.04; Ward's triangle, 1.85–2.21 GPa vs 3.98–4.13 GPa; p = 0.04; intertrochanteric region, 1.62–2.18 GPa vs 3.86–4.47 GPa; p = 0.006–0.007; greater trochanter, 0.65–1.21 GPa vs 1.96–2.62 GPa; p = 0.01–0.02), but no differences in bone mineral density T scores. There were weak relationships between the elastic moduli and bone mineral density T scores in patients with fractures (R2 = 0.25–0.31, P = 0.02-0.04), but not in control subjects.

Finite element analysis applied to high-resolution 3-T MR images of proximal femur microarchitecture can allow detection of  lower elastic modulus, a marker of bone strength, in subjects with fragility fractures compared with controls without fracture. Assessment of proximal femur strength may provide information about bone quality that is not captured by dual-energy x-ray absorptiometry.

MR imaging computation of markers of proximal femur strength could be used as an adjunct clinical care tool for detection of skeletal fragility and assessment of fracture risk, which would help physicians make treatment decisions.

Chang, G, Honig, S, Brown, R, Deniz, C, Egol, K, Babb, J, Regatte, R, Rajapakse, C, Finite Element Analysis Applied to High-Resolution 3 T MRI of Proximal Femur, Microarchitecture Detects Lower Bone Strength in Subjects with Fragility Fractures, Compared with Controls who Do not Differ by Bone Mineral Density.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14002763.html