Hip fracture is the most serious consequence of osteoporosis (OP). In 2002, the cost of treating hip fractures consumed 63% of the national direct expenditure for OP, or more than $10 billion. By 2050, due to a rapidly aging population, the annual cost of treating hip fractures is projected to increase 6 fold to more than $60 billion. The ability to accurately estimate an individual's risk of osteoporotic hip fracture is key in preventing the expected increase of hip fractures because it would identify those individuals needing the most potent available fracture reduction therapy. Bone Mineral Density (BMD) measurement is currently used for diagnosis of osteoporosis. However, it has only limited utility in predicting hip fracture. This is because Individual fracture risk is also strongly influenced by local bone architecture and structure, bone turnover, cortical thickness, and, fall biomechanics. We recently developed non- invasive automated imaging technology using ordinary radiographs that can measure cortical and trabecular parameters that are comparable to those measured by 3D uCT. Those 2D measurements correlated with biomechanical failure loads applied to cadaver proximal femoral bone cores as well to whole cadaver proximal femora. Furthermore, 2D mapping of structural parameters and watershed boundary detection in those same proximal femora appear to predict the location of osteoporotic fracture lines with a high degree of accuracy. Thus targeted measurement of trabecular parameters at a predicted fracture site could yield more precise and accurate estimates of failure load than those that are not at a predicted fracture site. Phase 1 of the preset Fast Track is designed to show that these observations are more than theoretical and that they can be used to develop a reference scale of cadaver fracture load values in Phase 2, along with a biomechanical component to predict individualized fracture risk. Finally that technology will be used attempt to predict hip fracture from pelvic radiographs obtained in the University of California, San Francisco prospective Study of Osteoporotic Fractures (SOF). Thus the present Fast Track Phase 1 and Phase 2 applications propose to develop powerful new technology that would identify individuals with OP at high risk for hip fracture so that they can be definitively treated. It is expected that this action could markedly reduce the morbidity, mortality and cost of this pervasive disease.
