Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Osteoporosis Reports
Published in: Current Osteoporosis Reports 6/2018

01-12-2018 | Imaging (T Lang and F Wehrli, Section Editors)

Micro-Finite Element Analysis of the Proximal Femur on the Basis of High-Resolution Magnetic Resonance Images

Authors: Chamith S. Rajapakse, Gregory Chang

Published in: Current Osteoporosis Reports | Issue 6/2018

Login to get access

Abstract

Purpose of Review

Hip fractures have catastrophic consequences. The purpose of this article is to review recent developments in high-resolution magnetic resonance imaging (MRI)-guided finite element analysis (FEA) of the hip as a means to determine subject-specific bone strength.

Recent Findings

Despite the ability of DXA to predict hip fracture, the majority of fractures occur in patients who do not have BMD T scores less than − 2.5. Therefore, without other detection methods, these individuals go undetected and untreated. Of methods available to image the hip, MRI is currently the only one capable of depicting bone microstructure in vivo. Availability of microstructural MRI allows generation of patient-specific micro-finite element models that can be used to simulate real-life loading conditions and determine bone strength.

Summary

MRI-based FEA enables radiation-free approach to assess hip fracture strength. With further validation, this technique could become a potential clinical tool in managing hip fracture risk.
Literature
1.
Nih Consensus Development Panel on Osteoporosis Prevention D, Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285(6):785–95.CrossRef
2.
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22(3):465–75.CrossRef
3.
Cooper Z, Mitchell SL, Lipsitz S, Harris MB, Ayanian JZ, Bernacki RE, et al. Mortality and readmission after cervical fracture from a fall in older adults: comparison with hip fracture using national Medicare data. J Am Geriatr Soc. 2015;63(10):2036–42.CrossRef
4.
Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc. 2002;50(10):1644–50.CrossRef
5.
Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359(9321):1929–36.CrossRef
6.
Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, et al. Assessment of fracture risk. Osteoporos Int. 2005;16(6):581–9.CrossRef
7.
Wainwright SA, Marshall LM, Ensrud KE, Cauley JA, Black DM, Hillier TA, et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. 2005;90(5):2787–93.CrossRef
8.
Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004;164(10):1108–12.CrossRef
9.
Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004;34(1):195–202.CrossRef
10.
Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19(4):385–97.CrossRef
11.
Kanis JA, Hans D, Cooper C, Baim S, Bilezikian JP, Binkley N, et al. Interpretation and use of FRAX in clinical practice. Osteoporos Int. 2011;22(9):2395–411.CrossRef
12.
Bonnick SL. HSA: beyond BMD with DXA. Bone. 2007;41(1 Suppl 1):S9–12.PubMed
13.
Beck TJ, Broy SB. Measurement of hip geometry-technical background. J Clin Densitom. 2015;18(3):331–7.CrossRef
14.
Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, et al. Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res. 2014;29(3):518–30.CrossRef
15.
Link TM, Lang TF. Axial QCT: clinical applications and new developments. J Clin Densitom. 2014;17(4):438–48.CrossRef
16.
Lang TF, Saeed IH, Streeper T, Carballido-Gamio J, Harnish RJ, Frassetto LA, et al. Spatial heterogeneity in the response of the proximal femur to two lower-body resistance exercise regimens. J Bone Miner Res. 2014;29(6):1337–45.CrossRef
17.
Treece GM, Gee AH, Tonkin C, Ewing SK, Cawthon PM, Black DM, et al. Predicting hip fracture type with cortical bone mapping (CBM) in the Osteoporotic Fractures in Men (MrOS) study. J Bone Miner Res. 2015;30(11):2067–77.CrossRef
18.
Johannesdottir F, Turmezei T, Poole KE. Cortical bone assessed with clinical computed tomography at the proximal femur. J Bone Miner Res. 2014;29(4):771–83.CrossRef
19.
Keaveny TM. Biomechanical computed tomography-noninvasive bone strength analysis using clinical computed tomography scans. Ann N Y Acad Sci. 2010;1192:57–65.CrossRef
20.
Keyak JH, Rossi SA, Jones KA, Les CM, Skinner HB. Prediction of fracture location in the proximal femur using finite element models. Med Eng Phys. 2001;23(9):657–64.CrossRef
21.
Nishiyama KK, Shane E. Clinical imaging of bone microarchitecture with HR-pQCT. Curr Osteoporos Rep. 2013;11(2):147–55.CrossRef
22.
Cheung AM, Adachi JD, Hanley DA, Kendler DL, Davison KS, Josse R, et al. High-resolution peripheral quantitative computed tomography for the assessment of bone strength and structure: a review by the Canadian Bone Strength Working Group. Curr Osteoporos Rep. 2013;11(2):136–46.CrossRef
23.
Wehrli FW. Structural and functional assessment of trabecular and cortical bone by micro magnetic resonance imaging. J Magn Reson Imaging. 2007;25(2):390–409.CrossRef
24.
Chang G, Boone S, Martel D, Rajapakse CS, Hallyburton RS, Valko M, et al. MRI assessment of bone structure and microarchitecture. J Magn Reson Imaging. 2017;46(2):323–37.CrossRef
25.
Link TM, Majumdar S, Augat P, Lin JC, Newitt D, Lu Y, et al. In vivo high resolution MRI of the calcaneus: differences in trabecular structure in osteoporosis patients. J Bone Miner Res. 1998;13(7):1175–82.CrossRef
26.
Majumdar S, Genant HK, Grampp S, Newitt DC, Truong VH, Lin JC, et al. Correlation of trabecular bone structure with age, bone mineral density, and osteoporotic status: in vivo studies in the distal radius using high resolution magnetic resonance imaging. J Bone Miner Res. 1997;12(1):111–8.CrossRef
27.
Wehrli FW, Hwang SN, Ma J, Song HK, Ford JC, Haddad JG. Cancellous bone volume and structure in the forearm: noninvasive assessment with MR microimaging and image processing. Radiology. 1998;206(2):347–57.CrossRef
28.
Krug R, Banerjee S, Han ET, Newitt DC, Link TM, Majumdar S. Feasibility of in vivo structural analysis of high-resolution magnetic resonance images of the proximal femur. Osteoporos Int. 2005;16(11):1307–14.CrossRef
29.
• Chang G, Deniz CM, Honig S, Rajapakse CS, Egol K, Regatte RR, et al. Feasibility of three-dimensional MRI of proximal femur microarchitecture at 3 tesla using 26 receive elements without and with parallel imaging. J Magn Reson Imaging. 2014;40(1):229–38 This study demonstrates the feasibility of generating microstructural MR images in human subjects. CrossRef
30.
• Han M, Chiba K, Banerjee S, Carballido-Gamio J, Krug R. Variable flip angle three-dimensional fast spin-echo sequence combined with outer volume suppression for imaging trabecular bone structure of the proximal femur. J Magn Reson Imaging. 2015;41(5):1300–10 This study demonstrates the feasibility of generating microstructural MR images in human subjects. CrossRef
31.
Rajapakse CS, Kobe EA, Batzdorf AS, Hast MW, Wehrli FW. Accuracy of MRI-based finite element assessment of distal tibia compared to mechanical testing. Bone. 2017;108:71–8.CrossRef
32.
van Rietbergen B, Majumdar S, Newitt D, MacDonald B. High-resolution MRI and micro-FE for the evaluation of changes in bone mechanical properties during longitudinal clinical trials: application to calcaneal bone in postmenopausal women after one year of idoxifene treatment. Clin Biomech (Bristol, Avon). 2002;17(2):81–8.CrossRef
33.
Al Mukaddam M, Rajapakse CS, Bhagat YA, Wehrli FW, Guo W, Peachey H, et al. Effects of testosterone and growth hormone on the structural and mechanical properties of bone by micro-MRI in the distal tibia of men with hypopituitarism. J Clin Endocrinol Metab. 2014;99(4):1236–44.CrossRef
34.
Rajapakse CS, Leonard MB, Kobe EA, Slinger MA, Borges KA, Billig E, et al. The efficacy of low-intensity vibration to improve bone health in patients with end-stage renal disease is highly dependent on compliance and muscle response. Acad Radiol. 2017;24(11):1332–42.CrossRef
35.
Wehrli FW, Rajapakse CS, Magland JF, Snyder PJ. Mechanical implications of estrogen supplementation in early postmenopausal women. J Bone Miner Res. 2010;25(6):1406–14.CrossRef
36.
Zhang XH, Liu XS, Vasilic B, Wehrli FW, Benito M, Rajapakse CS, et al. In vivo microMRI-based finite element and morphological analyses of tibial trabecular bone in eugonadal and hypogonadal men before and after testosterone treatment. J Bone Miner Res. 2008;23(9):1426–34.CrossRef
37.
Lam SC, Wald MJ, Rajapakse CS, Liu Y, Saha PK, Wehrli FW. Performance of the MRI-based virtual bone biopsy in the distal radius: serial reproducibility and reliability of structural and mechanical parameters in women representative of osteoporosis study populations. Bone. 2011;49(4):895–903.CrossRef
38.
Rajapakse CS, Leonard MB, Bhagat YA, Sun W, Magland JF, Wehrli FW. Micro-MR imaging-based computational biomechanics demonstrates reduction in cortical and trabecular bone strength after renal transplantation. Radiology. 2012;262(3):912–20.CrossRef
39.
Rajapakse CS, Phillips EA, Sun W, Wald MJ, Magland JF, Snyder PJ, et al. Vertebral deformities and fractures are associated with MRI and pQCT measures obtained at the distal tibia and radius of postmenopausal women. Osteoporos Int. 2014;25(3):973–82.CrossRef
40.
Wald MJ, Magland JF, Rajapakse CS, Bhagat YA, Wehrli FW. Predicting trabecular bone elastic properties from measures of bone volume fraction and fabric on the basis of micromagnetic resonance images. Magn Reson Med. 2012;68(2):463–73.CrossRef
41.
Wald MJ, Magland JF, Rajapakse CS, Wehrli FW. Structural and mechanical parameters of trabecular bone estimated from in vivo high-resolution magnetic resonance images at 3 tesla field strength. J Magn Reson Imaging. 2010;31(5):1157–68.CrossRef
42.
Bhagat YA, Rajapakse CS, Magland JF, Love JH, Wright AC, Wald MJ, et al. Performance of muMRI-based virtual bone biopsy for structural and mechanical analysis at the distal tibia at 7T field strength. J Magn Reson Imaging. 2011;33(2):372–81.CrossRef
43.
Chang G, Rajapakse CS, Babb JS, Honig SP, Recht MP, Regatte RR. In vivo estimation of bone stiffness at the distal femur and proximal tibia using ultra-high-field 7-Tesla magnetic resonance imaging and micro-finite element analysis. J Bone Miner Metab. 2012;30(2):243–51.CrossRef
44.
Chang G, Rajapakse CS, Diamond M, Honig S, Recht MP, Weiss DS, et al. Micro-finite element analysis applied to high-resolution MRI reveals improved bone mechanical competence in the distal femur of female pre-professional dancers. Osteoporos Int. 2013;24(4):1407–17.CrossRef
45.
Rajapakse CS, Magland J, Zhang XH, Liu XS, Wehrli SL, Guo XE, et al. Implications of noise and resolution on mechanical properties of trabecular bone estimated by image-based finite-element analysis. J Orthop Res. 2009;27(10):1263–71.CrossRef
46.
Zhang N, Magland JF, Rajapakse CS, Bhagat YA, Wehrli FW. Potential of in vivo MRI-based nonlinear finite-element analysis for the assessment of trabecular bone post-yield properties. Med Phys. 2013;40(5). 052303.CrossRef
47.
Zhang N, Magland JF, Rajapakse CS, Lam SB, Wehrli FW. Assessment of trabecular bone yield and post-yield behavior from high-resolution MRI-based nonlinear finite element analysis at the distal radius of premenopausal and postmenopausal women susceptible to osteoporosis. Acad Radiol. 2013;20(12):1584–91.CrossRef
48.
Carballido-Gamio J, Harnish R, Saeed I, Streeper T, Sigurdsson S, Amin S, et al. Proximal femoral density distribution and structure in relation to age and hip fracture risk in women. J Bone Miner Res. 2013;28(3):537–46.CrossRef
49.
Engelke K, Nagase S, Fuerst T, Small M, Kuwayama T, Deacon S, et al. The effect of the cathepsin K inhibitor ONO-5334 on trabecular and cortical bone in postmenopausal osteoporosis: the OCEAN study. J Bone Miner Res. 2014;29(3):629–38.CrossRef
50.
Yang L, Sycheva AV, Black DM, Eastell R. Site-specific differential effects of once-yearly zoledronic acid on the hip assessed with quantitative computed tomography: results from the HORIZON Pivotal Fracture Trial. Osteoporos Int. 2013;24(1):329–38.CrossRef
51.
Keaveny TM, McClung MR, Genant HK, Zanchetta JR, Kendler D, Brown JP, et al. Femoral and vertebral strength improvements in postmenopausal women with osteoporosis treated with denosumab. J Bone Miner Res. 2014;29(1):158–65.CrossRef
52.
Keyak JH, Sigurdsson S, Karlsdottir GS, Oskarsdottir D, Sigmarsdottir A, Kornak J, et al. Effect of finite element model loading condition on fracture risk assessment in men and women: the AGES-Reykjavik study. Bone. 2013;57(1):18–29.CrossRef
53.
Nishiyama KK, Ito M, Harada A, Boyd SK. Classification of women with and without hip fracture based on quantitative computed tomography and finite element analysis. Osteoporos Int. 2014;25(2):619–26.CrossRef
54.
Rajapakse CS, Magland JF, Wald MJ, Liu XS, Zhang XH, Guo XE, et al. Computational biomechanics of the distal tibia from high-resolution MR and micro-CT images. Bone. 2010;47(3):556–63.CrossRef
55.
• Chang G, Honig S, Brown R, Deniz CM, Egol KA, Babb JS, et al. Finite element analysis applied to 3-T MR imaging of proximal femur microarchitecture: lower bone strength in patients with fragility fractures compared with control subjects. Radiology. 2014;272(2):464–74 This study demontrate the usefulness of MRI-based FEA for assessment of proximal femur bone quality beyond the capabilities of DXA.CrossRef
56.
•• Rajapakse CS, Hotca A, Newman BT, Ramme A, Vira S, Kobe EA, et al. Patient-specific hip fracture strength assessment with microstructural mr imaging-based finite element modeling. Radiology. 2017;283(3):854–61 This study provides the technical details on how to implement nonlinear FEA on the basis of high-resolution MRI to determine the fracture strength of the proximal femur under real-life loading conditions. CrossRef
57.
Chang G, Hotca-Cho A, Rusinek H, Honig S, Mikheev A, Egol K, et al. Measurement reproducibility of magnetic resonance imaging-based finite element analysis of proximal femur microarchitecture for in vivo assessment of bone strength. MAGMA. 2015;28(4):407–12.CrossRef
58.
Chang G, Rajapakse CS, Regatte RR, Babb J, Saxena A, Belmont HM, et al. 3 Tesla MRI detects deterioration in proximal femur microarchitecture and strength in long-term glucocorticoid users compared with controls. J Magn Reson Imaging. 2015;42(6):1489–96.CrossRef
59.
Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC. Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA. 1994;271(2):128–33.CrossRef
60.
Keyak JH. Improved prediction of proximal femoral fracture load using nonlinear finite element models. Med Eng Phys. 2001;23(3):165–73.CrossRef
61.
Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94(6):646–50.
Metadata
Title
Micro-Finite Element Analysis of the Proximal Femur on the Basis of High-Resolution Magnetic Resonance Images
Authors
Chamith S. Rajapakse
Gregory Chang
Publication date
01-12-2018
Publisher
Springer US
Published in
Current Osteoporosis Reports / Issue 6/2018
Print ISSN: 1544-1873
Electronic ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-018-0481-5

Other articles of this Issue 6/2018

Current Osteoporosis Reports 6/2018 Go to the issue

Epidemiology and Pathophysiology (F Cosman and D Shoback Section Editors)

Recent Progress in Sarcopenia Research: a Focus on Operationalizing a Definition of Sarcopenia

Kidney and Bone (I Salusky and T Nickolas, Section Editors)

Non-renal-Related Mechanisms of FGF23 Pathophysiology

Bone and Joint Pain (T King and S Amin, Section Editors)

Mechanisms Underlying Bone and Joint Pain

Biomechanics (G Niebur and J Wallace, Section Editors)

In Vivo Osteocyte Mechanotransduction: Recent Developments and Future Directions

Kidney and Bone (I Salusky and T Nickolas, Section Editors)

Updates in CKD-Associated Osteoporosis

Kidney and Bone (I Salusky and T Nickolas, Section Editors)

Mineral and Bone Disease in Kidney Transplant Recipients