Can we improve the prediction of hip fracture by assessing bone structure using shape and appearance modelling?

► The use of active shape (ASM) and active appearance (AAM) modelling in the prediction of hip fracture is reported. ► ASM and AAM extract the variation in geometry and grey-scale respectively, from the collection of DXA images in the study. ► Shape and appearance modes were significant predictors of hip fracture, even after adjustment for BMD. ► A model containing BMD and shape and appearance modes gave the best prediction (AUC) of hip fracture.