February 9, 2023

In Silico Clinical Trials on Personalized Preventive Measures for Managing Hip Fractures in the Elderly

2nd Call, iDoc

Short Summary

The vast majority of hip fractures in the elderly are the result of falls from standing height or lower. These fractures are associated with high morbidity and mortality within the first 12 months post-fracture. Moreover, they create a significant strain on the health care systems due to the high cost of immediate and long-term treatment. Hence, developing accurate methods for identifying elderly individuals predisposed to hip fracture and developing methods for personalized preventive treatment so these devastating injuries can be avoided, is of great interest. In this project, which is a joint collaboration between ETH-Zurich, the Centre for Hip Health and Mobility, Vancouver, Canada and the Icelandic Heart Association, Kopavogur, Iceland, we will carry out a unique set of computational clinical trials for assessing the efficacy of the full spectrum of existing and novel treatment options for preventing hip fractures.

Goals

A solution to the near epidemiological problem of hip fracture in the elderly population has to address the two major shortcomings of current standard of care in parallel, which are the inability of current methods in identifying individuals at-risk prior to first fracture and the lack of effective treatment options once elevated risk is established. The specific aim of this research proposal is to address the latter, more specifically to carry out a series of in silico clinical trials for quantifying the biomechanical efficacy of novel minimally invasive personalized surgical procedures for preventing hip fractures.

Significance

Although the need for improved screening and treatment options for managing hip fracture risk in the elderly is evident, the question remains how cost effective it is to push development beyond the current standard of care. This project will through a series of computerizes clinical trials provide evidence on the biomechanical efficacy of different treatment options aimed at preventing hip fracture, which eventually will help inform clinicians and policy makers on how to best manage this problem in the aging population.

Background

Osteoporosis is one of the chronic diseases that significantly impacts the elderly population. It is characterized by reduced bone mass, resulting in increased bone fragility and increased fracture risk with age. Of all fracture types, hip fractures have the most severe socioeconomic consequences. Elevated hip fracture risk is generally addressed either pharmacologically or through life style interventions. However, the diagnosis of osteoporosis and thus the establishment of pathology is based on a statistical threshold (T-score) of bone density measurements (aBMD) that suffers from low sensitivity and is in fact not directly linked to the patient outcome that the clinicians want to prevent. Furthermore, pharmacological treatment, after fracture risk has been established, is ineffective in terms of preventing hip fractures. Life style changes on the other hand suffer from low patient compliance.

Publications

Ingmar Fleps, Halldór Pálsson, Alexander Baker, William Enns-Bray, Hassan Bahaloo, Michael Danner, Navrag B. Singh, William R. Taylor, Sigurdur Sigurdsson, Vilmundur Gudnason, Stephen J. Ferguson, Benedikt Helgason. Finite element derived femoral strength is a better predictor of hip fracture risk than aBMD in the AGES Reykjavik study cohort. Bone, Volume 154, January 2022, 116219.
Pall Asgeir Bjornsson, Alexander Baker, Ingmar Fleps, Yves Pauchard, Halldor Palsson, Stephen J. Ferguson, Sigurdur Sigurdsson, Vilmundur Gudnason, Benedikt Helgason, Lotta Maria Ellingsen. Fast and robust femur segmentation from computed tomography images for patient-specific hip fracture risk screening. Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization. 2022, 1-13.