Short-Term Precision Error of Bone Strain Index, a New DXA-Based Finite Element Analysis Software for Assessing Hip Strength

C. Messina, M. Acquasanta, L. Rinaudo, S. Tortora, G. Arena, D. Albano, L.M. Sconfienza, F.M. Ulivieri

Research output: Contribution to journalArticlepeer-review


Bone Strain Index (BSI) is a new finite element analysis tool applied to hip dual energy X-ray absorptiometry scans. The aim of this study was to assess the short-term precision error of BSI on the proximal femur, both on a phantom and patients. The International Society for Clinical Densitometry guidelines were followed for short-term precision error assessment. Dual energy X-ray absorptiometry measurements were performed on an anthropomorphic femur phantom that was scanned twice for 30 times, for a total of 60 scans. For the in vivo part, 30 subjects were scanned twice. BSI precision error was compared to that of bone mineral density (BMD). Both for the phantom and the in vivo study BSI reproducibility was lower compared to that of BMD, as the precision error of BSI resulted 3 times higher compared to that BMD. For phantom measurements, the highest precision value was that of total femur (TF) BMD (coefficient of variation [CoV] = 0.63%, reproducibility = 98.24%), while the lowest precision was the femoral neck (FN) BSI (CoV = 3.08%, reproducibility = 91.48%). Similarly, for the in vivo study, the highest precision was found at TF BMD (CoV = 1.36%, reproducibility = 96.22%), while the lowest value of precision was found for FN BSI (CoV = 4.17%, reproducibility = 88.46%). Reproducibility at TF was always better compared to that of the FN. BSI precision error was about 3 times higher compared to BMD, confirming previous results of lumbar spine BSI. The main source of variability of this new software is related to patient positioning.

Original languageEnglish
Pages (from-to)330-337
Number of pages8
JournalJournal of Clinical Densitometry
Issue number2
Publication statusPublished - 2021


  • Bone strain index
  • dual energy X-ray absorptiometry
  • finite element analysis
  • finite element method
  • osteoporosis
  • epoxy resin
  • hydroxyapatite
  • aged
  • Article
  • body mass
  • bone densitometry
  • bone density
  • bone mineral
  • bone stress
  • clinical article
  • controlled study
  • data analysis software
  • dual energy X ray absorptiometry
  • female
  • femoral neck
  • hip arthroplasty
  • hip fracture
  • human
  • in vivo study
  • lumbar spine
  • male
  • measurement accuracy
  • measurement error
  • patient positioning
  • priority journal
  • proximal femur
  • proximal femur fracture
  • devices
  • diagnostic imaging
  • femur
  • imaging phantom
  • metabolism
  • pathophysiology
  • photon absorptiometry
  • procedures
  • reproducibility
  • software
  • Absorptiometry, Photon
  • Aged
  • Bone Density
  • Female
  • Femur
  • Finite Element Analysis
  • Humans
  • Male
  • Osteoporosis
  • Patient Positioning
  • Phantoms, Imaging
  • Reproducibility of Results
  • Software


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