Comparison of 3D finite element analysis derived stiffness and BMD to determine the failure load of the excised proximal femur

IntroductionBone mineral density (BMD) is currently the preferred surrogate for bone strength in clinical practice. Finite element analysis (FEA) is a computer simulation technique that can predict the deformation of a structure when a load is applied, providing a measure of stiffness (N mm−1). Finite element analysis of X-ray images (3D-FEXI) is a FEA technique whose analysis is derived from a single 2D radiographic image.Methods18 excised human femora had previously been quantitative computed tomography scanned, from which 2D BMD-equivalent radiographic images were derived, and mechanically tested to failure in a stance-loading configuration. A 3D proximal femur shape was generated from each 2D radiographic image and used to construct 3D-FEA models.ResultsThe coefficient of determination (R2%) to predict failure load was 54.5% for BMD and 80.4% for 3D-FEXI.ConclusionsThis ex vivo study demonstrates that 3D-FEXI derived from a conventional 2D radiographic image has the potential to significantly increase the accuracy of failure load assessment of the proximal femur compared with that currently achieved with BMD. This approach may be readily extended to routine clinical BMD images derived by dual energy X-ray absorptiometry.