Prediction of femoral fracture load using automated finite element modeling

Hip fracture is an important cause of morbidity and mortality among the elderly. Current methods of assessing a patient's risk of hip fracture involve local estimates of bone density (densitometry), and are limited by their inability to account for the complex structural features of the femur. In an effort to improve clinical and research tools for assessing hip fracture risk, this study investigated whether automatically generated, computed tomographic (CT) scan-based finite element (FE) models can be used to estimate femoral fracture load in vitro. Eighteen pairs of femora were examined under two loading conditions - one similar to loading during the stance phase of gait, and one simulating impact from a fall. The femora were then mechanically tested to failure and regression analyses between measured fracture load and FE-predicted fracture load were performed. For comparison, densitometry measures were also examined. Significant relationships were found between measured fracture load and FE-predicted fracture load (r = 0.87, stance; r = 0.95, fall; r = 0.97, stance and fall data pooled) and between measured fracture load and densitometry data (r = 0.78, stance; r = 0.91, fall). These results indicate that this sophisticated technique, which is still early in its development, can achieve precision comparable to that of densitometry and can predict femoral fracture load to within -40% to + 60% with 95% confidence. Therefore, clinical use of this approach, which would require additional X-ray exposure and expenditure for a CT scan, is not justified at this point. Even so, the potential advantages of this CT/FE technique support further research in this area. (C) 1998 Elsevier Science Ltd. All rights reserved.