Bone Shape, Structure, and Density as Determinants of Osteoporotic Hip Fracture: A Pilot Study Investigating the Combination of Risk Factors.

摘要

OBJECTIVES:: This article compares and combines methods for examining the external shape and the internal structure of the proximal femur with bone mineral density (BMD) to provide a classifier for hip fracture. MATERIALS AND METHODS:: Fifty standard pelvic radiographs were available from age-matched fracture and control groups of postmenopausal women. Femoral shape was measured using an active shape model, the trabecular structure by means of a Fourier transform. RESULTS:: Both the shape and various structure measures were independent of BMD (P = 0.16 and >0.50, respectively). Calculating the area under the receiver operator characteristic (ROC) curve (Az), each of shape (Az = 0.81), the best structure measure (Az = 0.79-0.93), and BMD (Az = 0.79), could partially classify the fracture and control groups. However, the combination achieved almost perfect separation (Az = 0.99). CONCLUSIONS:: This pilot study shows how bone shape and structure can complement BMD measurements for investigations of fracture risk.