Are spontaneous fractures possible? An example of clinical application for personalised, multiscale neuro-musculo-skeletal modelling

Marco Viceconti, Fulvia Taddei, Saulo Martelli, Luca Cristofolini, Cristina Falcinelli, Enrico Schileo

    Research output: Contribution to journalArticle

    39 Citations (Scopus)

    Abstract

    Elderly frequently present variable degrees of osteopenia, sarcopenia, and neuromotor control degradation. Severely osteoporotic patients sometime fracture their femoral neck when falling. Is it possible that such fractures might occur without any fall, but rather spontaneously while the patient is performing normal movements such as level walking? The aim of this study was to verify if such spontaneous fractures are biomechanically possible, and in such case, which conditions of osteoporosis, sarcopenia, and neuromotor degradation could produce them. To the purpose, a probabilistic multiscale body-organ model validated against controlled experiments was used to predict the risk of spontaneous fractures in a population of 80-years old women, with normal weight and musculoskeletal anatomy, and variable degree of osteopenia, sarcopenia, and neuromotor control degradation. A multi-body inverse dynamics sub-model, coupled to a probabilistic neuromuscular sub-model, and to a femur finite element sub-model, formed the multiscale model, which was run within a Monte Carlo stochastic scheme, where the various parameters were varied randomly according to well defined distributions. The model predicted that neither extreme osteoporosis, nor extreme neuromotor degradation alone are sufficient to predict spontaneous fractures. However, when the two factors are combined an incidence of 0.4% of spontaneous fractures is predicted for the simulated population, which is consistent with clinical reports. When the model represented only severely osteoporotic patients, the incidence of spontaneous fractures increased to 29%. Thus, is biomechanically possible that spontaneous femoral neck fractures occur during level walking, due to a combination of severe osteoporosis and severe neuromotor degradation.

    Original languageEnglish
    Pages (from-to)421-426
    Number of pages6
    JournalJournal of Biomechanics
    Volume45
    Issue number3
    DOIs
    Publication statusPublished - 2 Feb 2012

    Keywords

    • Hip fracture
    • Multiscale model
    • Neuromotor degradation
    • Osteoporosis
    • Spontaneous fracture

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