DXA-derived biofidelic finite element models for quantifying the efficacy of hip protectors

Abstract

We aimed to develop a tool to predict the probability of hip fracture given a fall, using biofidelic finite element models (FEMs) built from DXA scans. Additionally, we evaluated the effectiveness of hip protectors, assuming full compliance, by quantifying the reduction in relative risk in-silico. This study included 700 subjects (325 males and 375 females) from the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) cohort, consisting of Chinese, Indian, and Malay ethnicities. The probability of hip fracture was calculated using DXA-based biofidelic FEMs by simulating various falls. The relative risk was determined by comparing fracture probabilities between falls with and without hip protectors. The overall probability of hip fracture in the cohort (mean age: 71.5 yr) was 4.49% (SD: 4.71). Chinese males had a significantly higher fracture risk, with odds ratios of 3.15 (95% CI: 1.81-5.49) compared to Malay males, and 4.57 (95% CI, 2.21-9.44) compared to Indian males. Similarly, Chinese females had a higher fracture risk, with odds ratios of 2.22 (95% CI, 1.16-4.24) compared to Malay females, and 7.70 (95% CI, 2.30-25.76) compared to Indian females. The relative risk with hip protectors was 0.38 (SD: 0.28) for males overall, with subgroup values of 0.42 (SD: 0.29) for Chinese, 0.33 (SD: 0.29) for Indians, and 0.38 (SD: 0.26) for Malays. For females, the overall relative risk was 0.43 (SD: 0.28), with subgroup values of 0.41 (SD: 0.21) for Chinese, 0.37 (SD: 0.32) for Indian, and 0.51 (SD: 0.29) for Malay, with no significant differences between ethnicities. In conclusion, we have developed an in-silico tool to assess hip fracture risk and evaluate the effectiveness of hip protectors using clinical DXA scans. These findings support the adoption of hip protectors as a preventive measure to reduce fracture risk. We developed an in-silico tool that uses clinically accessible DXA scans to estimate hip fracture risk in the event of a fall. The calculated probability reflects reported fracture risks across Singapore's three major ethnic groups. Our research also assessed the impact of hip protectors, revealing that consistent use of hip protectors significantly lowers the risk of hip fractures. These findings support a personalized strategy that integrates hip protectors with other preventive measures for high-risk subjects. They may also help healthcare providers in encouraging the regular use of hip protectors, thereby improving fracture prevention and care in clinical practice.