In vivo discrimination of hip fracture with quantitative computed tomography: Results from the prospective European Femur Fracture Study (EFFECT) |
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Authors: | Valérie Danielle Bousson Judith Adams Klaus Engelke Mounir Aout Martine Cohen‐Solal Catherine Bergot Didier Haguenauer Daniele Goldberg Karine Champion Redha Aksouh Eric Vicaut Jean‐Denis Laredo |
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Institution: | 1. Service de Radiologie OstéoArticulaire, Assistance Publique‐H?pitaux de Paris, H?pital Lariboisière, Paris, France;2. Laboratoire de Radiologie Expérimentale, Faculté de Médecine Lariboisière‐Saint Louis, Université Paris VII, Paris, France;3. Clinical Radiology, The Royal Infirmary, and Imaging Science and Biomedical Engineering, University of Manchester, Manchester, United Kingdom;4. Institute of Medical Physics, University of Erlangen, Erlangen, Germany;5. Unité de Recherche Clinique, Assistance Publique‐H?pitaux de Paris, H?pital Lariboisière, Paris, France;6. Service de Rhumatologie, Assistance Publique‐H?pitaux de Paris, H?pital Lariboisière, Paris, France;7. Service de Gérontologie, Assistance Publique‐H?pitaux de Paris, H?pital Sainte‐Périne, Paris, France;8. Service de Rhumatologie, Centre Médico Chirurgical Porte de Pantin, Paris, France;9. Service de Médecine A, Assistance Publique‐H?pitaux de Paris, H?pital Lariboisière, Paris, France |
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Abstract: | In assessing osteoporotic fractures of the proximal femur, the main objective of this in vivo case‐control study was to evaluate the performance of quantitative computed tomography (QCT) and a dedicated 3D image analysis tool Medical Image Analysis Framework—Femur option (MIAF‐Femur)] in differentiating hip fracture and non–hip fracture subjects. One‐hundred and seven women were recruited in the study, 47 women (mean age 81.6 years) with low‐energy hip fractures and 60 female non–hip fracture control subjects (mean age 73.4 years). Bone mineral density (BMD) and geometric variables of cortical and trabecular bone in the femoral head and neck, trochanteric, and intertrochanteric regions and proximal shaft were assessed using QCT and MIAF‐Femur. Areal BMD (aBMD) was assessed using dual‐energy X‐ray absorptiometry (DXA) in 96 (37 hip fracture and 59 non–hip fracture subjects) of the 107 patients. Logistic regressions were computed to extract the best discriminates of hip fracture, and area under the receiver characteristic operating curve (AUC) was calculated. Three logistic models that discriminated the occurrence of hip fracture with QCT variables were obtained (AUC = 0.84). All three models combined one densitometric variable—a trabecular BMD (measured in the femoral head or in the trochanteric region)—and one geometric variable—a cortical thickness value (measured in the femoral neck or proximal shaft). The best discriminant using DXA variables was obtained with total femur aBMD (AUC = 0.80, p = .003). Results highlight a synergistic contribution of trabecular and cortical components in hip fracture risk and the utility of assessing QCT BMD of the femoral head for improved understanding and possible insights into prevention of hip fractures. © 2011 American Society for Bone and Mineral Research. |
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Keywords: | BONE MINERAL DENSITY (BMD) CORTICAL BONE HIP FRACTURE OSTEOPOROSIS QUANTITATIVE COMPUTED TOMOGRAPHY (QCT) |
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