A multiscale model to predict current absolute risk of femoral fracture in a postmenopausal population

Bhattacharya, Pinaki and Altai, Zainab and Qasim, Muhammad and Viceconti, Marco (2019) A multiscale model to predict current absolute risk of femoral fracture in a postmenopausal population. Biomechanics and Modeling in Mechanobiology, 18 (2). pp. 301-318. ISSN 1617-7940

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Official URL: http://dx.doi.org/10.1007/s10237-018-1081-0

Abstract

Osteoporotic hip fractures are a major healthcare problem. Fall severity and bone strength are important risk factors of hip fracture. This study aims to obtain a mechanistic explanation for fracture risk in dependence of these risk factors. A novel modelling approach is developed that combines models at different scales to overcome the challenge of a large space–time domain of interest and considers the variability of impact forces between potential falls in a subject. The multiscale model and its component models are verified with respect to numerical approximations made therein, the propagation of measurement uncertainties of model inputs is quantified, and model predictions are validated against experimental and clinical data. The main results are model predicted absolute risk of current fracture (ARF0) that ranged from 1.93 to 81.6% (median 36.1%) for subjects in a retrospective cohort of 98 postmenopausal British women (49 fracture cases and 49 controls); ARF0 was computed up to a precision of 1.92 percentage points (pp) due to numerical approximations made in the model; ARF0 possessed an uncertainty of 4.00 pp due to uncertainties in measuring model inputs; ARF0 classified observed fracture status in the above cohort with AUC = 0.852 (95% CI 0.753–0.918), 77.6% specificity (95% CI 63.4–86.5%) and 81.6% sensitivity (95% CI 68.3–91.1%). These results demonstrate that ARF0 can be computed using the model with sufficient precision to distinguish between subjects and that the novel mechanism of fracture risk determination based on fall dynamics, hip impact and bone strength can be considered validated.

Item Type: Journal Article
Keywords: Multiscale model, Osteoporotic hip fracture, Uncertainty quantification, Validation, Verification
Faculty: Faculty of Science & Technology
SWORD Depositor: Symplectic User
Depositing User: Symplectic User
Date Deposited: 01 Apr 2019 14:32
Last Modified: 16 Jul 2019 09:39
URI: http://arro.anglia.ac.uk/id/eprint/704219

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