Dual-energy X-ray absorptiometry 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 built from dual-energy X-ray absorptiometry (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 finite element models 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 years) was 4.49% (Standard deviation (SD): 4.71). Chinese males had a significantly higher fracture risk, with odds ratios of 3.15 (95% confidence interval (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 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. 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 preventative measure to reduce fracture risk.