IBMS BoneKEy | BoneKEy Watch
Derikx et al. New approaches to predicting fracture risk due to bone metastasis
DOI:10.1038/bonekey.2015.107
Metastasis to bone frequently occurs in many forms of advanced cancer. The strength of the affected bone is significantly reduced, increasing the risk of fracture. Predicting which bones will fracture is extremely difficult in clinical practice; in this review Derikx and colleagues look at the potential quantitative and objective approaches that may help optimize preventive treatment.
They conclude that both CT-based rigidity analysis (CTRA modeling) and patient-specific finite element modeling (FE modeling) are promising, noting that FE models are often better than expert clinical assessment in experimental situations.
A prospective cohort study in progress by the authors in 66 patients with femoral metastases has revealed that load capacity in patients who sustain a fracture is significantly lower than in those that do not. However, their findings confirm that accuracy at the individual patient level needs to be improved before FE modeling can be used clinically. They observe that new modeling and imaging technologies can and should be used to improve predictive capacity of FE and CTRA tools.
Editor's comment: Finite element models outperform clinical experts in the evaluation of in vitro bone strength in presence of metastatic defects. On the one hand, this promising result requires confirmation in well-designed clinical trials. On the other hand, finite element models necessitate further improvements as well as full automation in order to find their way in clinical practice.
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