We reviewed the experimental and clinical evidence that hip bone strength estimated by BMD and/or finite element analysis (FEA) reflects the actual strength of the proximal femur and is associated with hip fracture risk and its changes upon treatment. INTRODUCTION The risk of hip fractures increases exponentially with age due to a progressive loss of bone mass, deterioration of bone structure, and increased incidence of falls. Areal bone mineral density (aBMD), measured by dual-energy X-ray absorptiometry (DXA), is the most used surrogate marker of bone strength. However, age-related declines in bone strength exceed those of aBMD, and the majority of fractures occur in those who are not identified as osteoporotic by BMD testing. With hip fracture incidence increasing worldwide, the development of accurate methods to estimate bone strength in vivo would be very useful to predict the risk of hip fracture and to monitor the effects of osteoporosis therapies. METHODS We reviewed experimental and clinical evidence regarding the association between aBMD and/orCT-finite element analysis (FEA) estimated femoral strength and hip fracture risk as well as their changes with treatment. RESULTS Femoral aBMD and bone strength estimates by CT-FEA explain a large proportion of femoral strength ex vivo and predict hip fracture risk in vivo. Changes in femoral aBMD are strongly associated with anti-fracture efficacy of osteoporosis treatments, though comparable data for FEA are currently not available. CONCLUSIONS Hip aBMD and estimated femoral strength are good predictors of fracture risk and could potentially be used as surrogate endpoints for fracture in clinical trials. Further improvements of FEA may be achieved by incorporating trabecular orientations, enhanced cortical modeling, effects of aging on bone tissue ductility, and multiple sideway fall loading conditions.

中文翻译：

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股骨力量无创评估在评估髋部骨折风险中的观点。

我们回顾了实验和临床证据，即通过BMD和/或有限元分析（FEA）估算的髋骨强度反映了股骨近端的实际强度，并与髋部骨折风险及其治疗后的变化有关。简介髋骨骨折的风险随着年龄的增长而成倍增加，这是由于骨量的逐渐减少，骨结构的恶化以及跌倒的发生率增加所致。通过双能X射线骨密度仪（DXA）测量的骨矿物质密度（aBMD）是最常用的骨强度替代指标。但是，与年龄相关的骨骼强度下降幅度超过了aBMD下降幅度，并且大多数骨折发生在BMD测试未鉴定为骨质疏松的患者中。随着世界范围内髋部骨折发生率的增加，因此，开发准确的方法来估算体内的骨强度对于预测髋部骨折的风险和监测骨质疏松疗法的效果非常有用。方法我们回顾了有关aBMD和/或CT有限元分析（FEA）估算的股骨强度和髋部骨折风险及其随治疗的变化之间的关系的实验和临床证据。结果CT-FEA对股骨aBMD和骨强度的估计解释了离体股骨强度的大部分，并预测了体内髋部骨折的风险。股骨aBMD的变化与骨质疏松症治疗的抗骨折功效密切相关，尽管目前尚无FEA的可比数据。结论髋关节aBMD和估计的股骨强度是骨折风险的良好预测指标，并有可能在临床试验中用作骨折的替代终点。通过合并小梁方向，增强的皮质模型，衰老对骨组织延展性的影响以及多个侧向跌落载荷条件，可以实现FEA的进一步改善。