Bone strain index in the prediction of vertebral fragility refracture

Fabio Massimo Ulivieri, Luca Petruccio Piodi, Luca Rinaudo, Paolo Scanagatta, Bruno Mario Cesana

Research output: Contribution to journalArticlepeer-review


Dual-energy x-ray absorptiometry (DXA) can provide quantitative (bone mineral density, BMD) and qualitative (trabecular bone score, TBS) indexes of bone status, able to predict fragility fractures in most osteoporotic patients. A new qualitative index of bone strength, based on finite element analysis and named bone strain index (BSI), has been recently developed from lumbar DXA scan. We present the preliminary results about the BSI ability to predict a refracture in patients with fragility fractures. A total of 143 consecutive fractured patients with primary osteoporosis (121 females) performed a spine x-ray examination for the calculation of spine deformity index (SDI) and a DXA densitometry for BMD, TBS, and BSI at basal time and in the follow-up. A refracture was considered as a one-unit increase in SDI. For each unit increase of the investigated indexes, the hazard ratio of refracture, 95% confidence interval, p value, and proportionality test p value were for BSI 1.201, 0.982−1.468, 0.074, and 0.218; for lumbar BMD 0.231, 0.028−1.877, 0.170, and 0.305; and for TBS 0.034, 0.001−2.579, 0.126, and 0.518, respectively. BSI was the index predictive of refracture nearest to statistical significance. If confirmed, it may be used for a better risk assessment of osteoporotic patients.

Original languageEnglish
Article number23
JournalEuropean radiology experimental
Issue number1
Publication statusPublished - Dec 1 2020


  • Absorptiometry (dual-energy x-ray)
  • Bone density
  • Bone fractures
  • Finite element analysis
  • Osteoporosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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