Advanced 2D image processing technique to predict hip fracture risk in an older population based on single DXA scans

Summary A new technique to enhance hip fracture risk prediction in older adults was presented and assessed. The new method dramatically improved prediction at high specificity levels using only a standard clinical diagnostic scan. This has the potential to be implemented in clinical practice to enha...

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Bibliographic Details
Published in:Osteoporosis international 2020-10, Vol.31 (10), p.1925-1933
Main Authors: Jazinizadeh, F., Adachi, J.D., Quenneville, C.E.
Format: Article
Language:English
Subjects:
Absorptiometry, Photon
Aged
Body mass index
Bone Density
Bone mineral density
Canada - epidemiology
Clinical medicine
Diagnosis
Dual energy X-ray absorptiometry
Endocrinology
Femur
Fractures
Hip
Hip Fractures - diagnostic imaging
Hip Fractures - epidemiology
Hip Fractures - etiology
Hip joint
Humans
Image processing
Mathematical models
Medical imaging
Medicine
Medicine & Public Health
Original Article
Orthopedics
Osteoporosis
Osteoporosis - complications
Osteoporosis - diagnostic imaging
Osteoporosis - epidemiology
Patients
Predictions
Rheumatology
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Summary:Summary A new technique to enhance hip fracture risk prediction in older adults was presented and assessed. The new method dramatically improved prediction at high specificity levels using only a standard clinical diagnostic scan. This has the potential to be implemented in clinical practice to enhance patient fragility diagnosis. Introduction Diagnosis of osteoporosis is based on the measurement of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) scans. However, studies have shown this to be insufficient to accurately predict hip fractures. Therefore, complementary methods are needed to enhance hip fracture risk prediction to identify vulnerable patients. Methods Hip DXA scans were obtained for 192 subjects from the Canadian Multicenter Osteoporosis Study (CaMos), 50 of whom had experienced a hip fracture within 5 years of the scan. 2D statistical shape and appearance modeling was performed to account for the effect of the femur’s geometry and BMD distribution on hip fracture risk. Statistical shape modeling (SSM), and statistical appearance modeling (SAM) were also used separately to predict the fracture risk based solely on the femur’s geometry and BMD distribution, respectively. Combined with BMD, age, and body mass index (BMI), logistic regression was performed to estimate the fracture risk over the 5-year period. Results Using the new technique, hip fractures were correctly predicted in 78% of cases compared with 36% when using the T-score. The accuracy of the prediction was not greatly reduced when using SSM and SAM (78% and 74% correct, respectively). Various geometric and BMD distribution traits were identified in the fractured and non-fractured groups. Conclusion 2D SSAM can dramatically improve hip fracture prediction at high specificity levels and estimate the year of the impending fracture using standard clinical images. This has the potential to be implemented in clinical practice to estimate hip fracture risk.
ISSN:0937-941X
1433-2965
DOI:10.1007/s00198-020-05444-7