Inelastic Mechanical Descriptors for Osteoporotic Hip Fracture Discrimination with 3D-DXA-Based Nonlinear Finite Element Models

Inelastic Mechanical Descriptors for Osteoporotic Hip Fracture Discrimination with 3D-DXA-Based Nonlinear Finite Element Models | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Inelastic Mechanical Descriptors for Osteoporotic Hip Fracture Discrimination with 3D-DXA-Based Nonlinear Finite Element Models Elham Alizadeh, Carlos Ruiz Wills, Luis del Rio, Silvana Di Gregorio, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6556529/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. Advances in 2D-3D modelling to generate patient-specific 3D-DXA models out of DXA images enable accurate volumetric representations of the femur, with potential for fracture risk prediction when combined with finite element (FE) analyses. This study evaluates the ability of 3D-DXA-based FE models to discriminate hip fractures under side-fall loading. We used a retrospective case-control study including 128 women, 64 of whom suffered a hip fracture. Mechanical descriptors, including strength, nonlinear deformation, residual displacement, and energy absorption under elastic-plastic assumptions, were derived from force-displacement curves. The area under the receiver operating characteristic curve (AUROC) showed that strength and trabecular vBMD equally discriminated between fracture and control subjects. Residual displacement due to plastic strain accumulation at failure emerged as a key descriptor which, when combined with strength, significantly improved fracture discrimination (ΔAUROC = 0.11 vs. aBMD; ΔAUROC = 0.08 vs. trabecular vBMD). These findings highlight the potential of 3D-DXA and FE modelling to improve fracture assessment within current DXA-based clinical workflows. Physical sciences/Engineering/Biomedical engineering Physical sciences/Engineering/Mechanical engineering Biomechanics Osteoporosis Hip fracture discrimination 3D-DXA Finite element Full Text Additional Declarations Competing interest reported. All authors declare no conflicts of interest. Ludovic Humbert is an employee and shareholder of 3D-Shaper Medical. Supplementary Files HipFractureDiscriminationSupplementaryInformation.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6556529","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":458510850,"identity":"0cca61d0-17c6-46c6-81aa-8bba4a9779b3","order_by":0,"name":"Elham Alizadeh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYDACdh4wJcMGJCQYG2wYGJgPMDDw4NPCDJHlgWpJY2BgSyBSCwNEy2HCWviZeQ9+usFgx8PHf/jhjY87ziduZ2NgfPC2DbcWyWa+ZOkchmSgw44ZW848cztxZxsDs+FcPFoMDvMYALUw87AxNphJ87bdTtxwv4ENyMCtxf4wj/HvHIZ6HjZm9m/Sf9vOJW44xsD+G58WA2YeM6Ath3nY2IAMxrYDIC1szPi0SBzmMbPOMTjOw8bDU2zZ25ZsvLONsVlyzjncWvjbe4xv51RUy8n3H99442ebnex2NuaDH96U4dYCdR4Km7GBkHo82kfBKBgFo2AUgAAAS8hGVbeDyqoAAAAASUVORK5CYII=","orcid":"","institution":"Pompeu Fabra University","correspondingAuthor":true,"prefix":"","firstName":"Elham","middleName":"","lastName":"Alizadeh","suffix":""},{"id":458510851,"identity":"712fd1ea-1280-4afa-a2b2-ee9ec5a00c06","order_by":1,"name":"Carlos Ruiz Wills","email":"","orcid":"","institution":"Pompeu Fabra University","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"Ruiz","lastName":"Wills","suffix":""},{"id":458510852,"identity":"5f1ad137-7c06-4823-a580-dcaa8f11df5d","order_by":2,"name":"Luis del Rio","email":"","orcid":"","institution":"CETIR Ascires","correspondingAuthor":false,"prefix":"","firstName":"Luis","middleName":"del","lastName":"Rio","suffix":""},{"id":458510854,"identity":"f2063864-1461-405d-b153-6337da9bb251","order_by":3,"name":"Silvana Di Gregorio","email":"","orcid":"","institution":"CETIR Ascires","correspondingAuthor":false,"prefix":"","firstName":"Silvana","middleName":"Di","lastName":"Gregorio","suffix":""},{"id":458510856,"identity":"7935610d-03fd-4652-91c9-01213b03c02f","order_by":4,"name":"Ludovic Humbert","email":"","orcid":"","institution":"3D-Shaper Medical","correspondingAuthor":false,"prefix":"","firstName":"Ludovic","middleName":"","lastName":"Humbert","suffix":""},{"id":458510858,"identity":"b5da95cb-c72d-43d7-ba2d-ba32fa9d0282","order_by":5,"name":"Jérôme Noailly","email":"","orcid":"","institution":"Pompeu Fabra University","correspondingAuthor":false,"prefix":"","firstName":"Jérôme","middleName":"","lastName":"Noailly","suffix":""}],"badges":[],"createdAt":"2025-04-29 12:38:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6556529/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6556529/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85789174,"identity":"e52785f6-7c4d-400b-91c8-b95a4a64388c","added_by":"auto","created_at":"2025-07-01 17:01:37","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":579868,"visible":true,"origin":"","legend":"","description":"","filename":"HipFractureDiscriminationRevisedMay12.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6556529/v1_covered_96debb0f-9826-4d18-b921-94138ccc3890.pdf"},{"id":83161584,"identity":"4fc25672-43b9-4542-ba9c-230da75d9248","added_by":"auto","created_at":"2025-05-20 15:18:06","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":627231,"visible":true,"origin":"","legend":"","description":"","filename":"HipFractureDiscriminationSupplementaryInformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-6556529/v1/16a89cd9228fbd38daf13acc.docx"}],"financialInterests":"Competing interest reported. 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Advances in 2D-3D modelling to generate patient-specific 3D-DXA models out of DXA images enable accurate volumetric representations of the femur, with potential for fracture risk prediction when combined with finite element (FE) analyses. This study evaluates the ability of 3D-DXA-based FE models to discriminate hip fractures under side-fall loading. We used a retrospective case-control study including 128 women, 64 of whom suffered a hip fracture. Mechanical descriptors, including strength, nonlinear deformation, residual displacement, and energy absorption under elastic-plastic assumptions, were derived from force-displacement curves. The area under the receiver operating characteristic curve (AUROC) showed that strength and trabecular vBMD equally discriminated between fracture and control subjects. Residual displacement due to plastic strain accumulation at failure emerged as a key descriptor which, when combined with strength, significantly improved fracture discrimination (ΔAUROC\u0026thinsp;=\u0026thinsp;0.11 vs. aBMD; ΔAUROC\u0026thinsp;=\u0026thinsp;0.08 vs. trabecular vBMD). These findings highlight the potential of 3D-DXA and FE modelling to improve fracture assessment within current DXA-based clinical workflows.\u003c/p\u003e","manuscriptTitle":"Inelastic Mechanical Descriptors for Osteoporotic Hip Fracture Discrimination with 3D-DXA-Based Nonlinear Finite Element Models","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-20 15:18:01","doi":"10.21203/rs.3.rs-6556529/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1979a55e-2648-478d-bab7-ad101157a044","owner":[],"postedDate":"May 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":48706850,"name":"Physical sciences/Engineering/Biomedical engineering"},{"id":48706851,"name":"Physical sciences/Engineering/Mechanical engineering"}],"tags":[],"updatedAt":"2025-07-01T16:53:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-20 15:18:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6556529","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6556529","identity":"rs-6556529","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}