Comparison of 3D finite element analysis derived stiffness and BMD to determine the failure load of the excised proximal femur

Bone mineral density (BMD) is currently the preferred surrogate for bone strength in clinical practice. Finite element analysis (FEA) is a computer simulation technique that can predict the deformation of a structure when a load is applied, providing a measure of stiffness (N mm− 1). Finite element analysis of X-ray images (3D-FEXI) is a FEA technique whose analysis is derived from a single 2D radiographic image. This ex-vivo study demonstrates that 3D-FEXI derived from a conventional 2D radiographic image has the potential to significantly increase the accuracy of failure load assessment of the proximal femur compared with that currently achieved with BMD.