{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T08:36:35Z","timestamp":1793522195276,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T00:00:00Z","timestamp":1512086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,12,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2003<\/jats:title>\n                  <jats:p>Multiple myeloma (MM) is a malignant plasma cell disease associated with severe bone destruction. Surgical intervention is often required to prevent vertebral body collapse and resulting neurological complications; however, its necessity is determined by measuring lesion size or number, without considering bone biomechanics. Finite element (FE) modeling, which simulates the physiological loading, may improve the prediction of fragility. To test this, we developed a quantitative computed tomography (QCT)-based FE model of the vertebra and applied it to a dataset of MM patients with and without prevalent fracture. FE models were generated from vertebral QCT scans of the T12 (T11 if T12 was fractured) of 104 MM patients, 45 with fracture and 59 without, using a low-dose scan protocol (1.5\u2009mm slice thickness, 4.0 to 6.5 mSv effective dose). A calibration phantom enabled the conversion of the CT Hounsfield units to FE material properties. Compressive loading of the vertebral body was simulated and the stiffness, yield load, and work to yield determined. To compare the parameters between fracture and nonfracture groups, t tests were used, and standardized odds ratios (sOR, normalized to standard deviation) and 95% confidence intervals were calculated. FE parameters were compared to mineral and structural parameters using linear regression. Patients with fracture showed lower vertebral stiffness (\u201315.2%; p\u2009=\u20090.010; sOR\u2009=\u20091.73; 95% CI, 1.11 to 2.70), yield force (\u201321.5%; p\u2009=\u20090.002; sOR\u2009=\u20092.09; 95% CI, 1.27 to 3.43), and work to yield (\u201327.4%; p\u2009=\u20090.001; sOR\u2009=\u20092.28; 95% CI, 1.33 to 3.92) compared to nonfracture patients. All parameters correlated significantly with vBMD (stiffness: R2\u2009=\u20090.57, yield force: R2\u2009=\u20090.59, work to yield: R2\u2009=\u20090.50, p &amp;lt; 0.001), BV\/TV (stiffness: R2\u2009=\u20090.56, yield force: R2\u2009=\u20090.58, work to yield: R2\u2009=\u20090.49, p &amp;lt; 0.001), and Tb.Sp (stiffness: R2\u2009=\u20090.51, yield force: R2\u2009=\u20090.53, work to yield: R2\u2009=\u20090.45, p &amp;lt; 0.001). FE modeling identified MM patients with compromised mechanical integrity of the vertebra. Higher sOR values were obtained for the biomechanical compared to structural or mineral measures, suggesting that FE modeling improves fragility assessment in these patients. \u00a9 2016 American Society for Bone and Mineral Research.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/jbmr.2924","type":"journal-article","created":{"date-parts":[[2016,7,25]],"date-time":"2016-07-25T19:57:01Z","timestamp":1469476621000},"page":"151-156","source":"Crossref","is-referenced-by-count":19,"title":["Assessment of Bone Fragility in Patients With Multiple Myeloma Using QCT-Based Finite Element Modeling"],"prefix":"10.1093","volume":"32","author":[{"given":"Graeme M","family":"Campbell","sequence":"first","affiliation":[{"name":"Institute of BiomechanicsHamburg University of TechnologyHamburgGermany"},{"name":"Section Biomedical ImagingDepartment of Radiology and NeurologyUniversity Hospital Schleswig-HolsteinKielGermany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime A","family":"Pe\u00f1a","sequence":"additional","affiliation":[{"name":"Section Biomedical ImagingDepartment of Radiology and NeurologyUniversity Hospital Schleswig-HolsteinKielGermany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Giravent","sequence":"additional","affiliation":[{"name":"Section Biomedical ImagingDepartment of Radiology and NeurologyUniversity Hospital Schleswig-HolsteinKielGermany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Thomsen","sequence":"additional","affiliation":[{"name":"National Scientific and Technical Research Council (CONICET)National University of the SouthBah\u00eda BlancaArgentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Damm","sequence":"additional","affiliation":[{"name":"Section Biomedical ImagingDepartment of Radiology and NeurologyUniversity Hospital Schleswig-HolsteinKielGermany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus-C","family":"Gl\u00fcer","sequence":"additional","affiliation":[{"name":"Section Biomedical ImagingDepartment of Radiology and NeurologyUniversity Hospital Schleswig-HolsteinKielGermany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Borggrefe","sequence":"additional","affiliation":[{"name":"Institut und Poliklinik f\u00fcr Diagnostische RadiologieUniklinik K\u00f6lnK\u00f6lnGermany"},{"name":"Section Biomedical ImagingDepartment of Radiology and NeurologyUniversity Hospital Schleswig-HolsteinKielGermany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,12,1]]},"reference":[{"issue":"1","key":"2024021014262178600_jbmr2924-bib-0001","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1148\/radiol.2311020452","article-title":"Multiple myeloma: clinical review and diagnostic imaging","volume":"231","author":"Angtuaco","year":"2004","journal-title":"Radiology"},{"issue":"9686","key":"2024021014262178600_jbmr2924-bib-0002","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/S0140-6736(09)60221-X","article-title":"Multiple myeloma","volume":"374","author":"Raab","year":"2009","journal-title":"Lancet"},{"issue":"3","key":"2024021014262178600_jbmr2924-bib-0003","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1359\/JBMR.041131","article-title":"Fracture risk with multiple myeloma: a population-based study","volume":"20","author":"Melton","year":"2005","journal-title":"J Bone Miner Res"},{"issue":"3","key":"2024021014262178600_jbmr2924-bib-0004","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1097\/00004728-199805000-00016","article-title":"Development of vertebral fractures in patients with multiple myeloma: does MRI enable recognition of vertebrae that will 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Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival","volume":"36","author":"Durie","year":"1975","journal-title":"Cancer"},{"issue":"9","key":"2024021014262178600_jbmr2924-bib-0011","first-page":"874","article-title":"[Staging of multiple myeloma with MRI: comparison to MSCT and conventional radiography]","volume":"44","author":"Baur-Melnyk","year":"2004","journal-title":"Radiologe"},{"issue":"3","key":"2024021014262178600_jbmr2924-bib-0012","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.ejrad.2009.02.005","article-title":"Imaging in multiple myeloma","volume":"70","author":"Delorme","year":"2009","journal-title":"Eur J Radiol"},{"issue":"6","key":"2024021014262178600_jbmr2924-bib-0013","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1016\/j.bone.2011.02.005","article-title":"Advanced imaging assessment of bone fragility in glucocorticoid-induced osteoporosis","volume":"48","author":"Kalpakcioglu","year":"2011","journal-title":"Bone"},{"issue":"4","key":"2024021014262178600_jbmr2924-bib-0014","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/S8756-3282(03)00210-2","article-title":"Finite element models predict in vitro vertebral body compressive strength better than quantitative computed tomography","volume":"33","author":"Crawford","year":"2003","journal-title":"Bone"},{"issue":"4","key":"2024021014262178600_jbmr2924-bib-0015","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1002\/jbmr.1539","article-title":"Prediction of new clinical vertebral fractures in elderly men using finite element analysis of CT scans","volume":"27","author":"Wang","year":"2012","journal-title":"J Bone Miner Res"},{"issue":"3","key":"2024021014262178600_jbmr2924-bib-0016","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/S1350-4533(01)00045-5","article-title":"Improved prediction of proximal femoral fracture load using nonlinear finite element models","volume":"23","author":"Keyak","year":"2001","journal-title":"Med Eng Phys"},{"issue":"2","key":"2024021014262178600_jbmr2924-bib-0017","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.ejrad.2004.04.015","article-title":"Whole-body low-dose multidetector row-CT in the diagnosis of multiple myeloma: an alternative to conventional radiography","volume":"54","author":"Horger","year":"2005","journal-title":"Eur J Radiol"},{"issue":"11","key":"2024021014262178600_jbmr2924-bib-0018","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1016\/j.ejrad.2015.07.024","article-title":"Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma","volume":"84","author":"Borggrefe","year":"2015","journal-title":"Eur J Radiol"},{"issue":"7","key":"2024021014262178600_jbmr2924-bib-0019","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1002\/jbmr.2443","article-title":"Association of QCT bone mineral density and bone structure with vertebral fractures in patients with multiple myeloma","volume":"30","author":"Borggrefe","year":"2015","journal-title":"J Bone Miner Res"},{"issue":"9","key":"2024021014262178600_jbmr2924-bib-0020","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1002\/jbmr.5650080915","article-title":"Vertebral fracture assessment using a semiquantitative technique","volume":"8","author":"Genant","year":"1993","journal-title":"J Bone Miner Res"},{"key":"2024021014262178600_jbmr2924-bib-0021","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.bone.2015.07.036","article-title":"Administration of romosozumab improves vertebral trabecular and cortical bone as assessed with quantitative computed tomography and finite element analysis","volume":"81","author":"Graeff","year":"2015","journal-title":"Bone"},{"issue":"10","key":"2024021014262178600_jbmr2924-bib-0022","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1359\/jbmr.090416","article-title":"Improvements in vertebral body strength under teriparatide treatment assessed in vivo by finite element analysis: results from the EUROFORS study","volume":"24","author":"Graeff","year":"2009","journal-title":"J Bone Miner Res"},{"issue":"2","key":"2024021014262178600_jbmr2924-bib-0023","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.bone.2012.10.036","article-title":"High resolution quantitative computed tomography-based assessment of trabecular microstructure and strength estimates by finite-element analysis of the spine, but not DXA, reflects vertebral fracture status in men with glucocorticoid-induced osteoporosis","volume":"52","author":"Graeff","year":"2013","journal-title":"Bone"},{"issue":"5","key":"2024021014262178600_jbmr2924-bib-0024","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1046\/j.1365-2141.2003.04355.x","article-title":"International Myeloma Working Group. 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