Institution: Radboud University, Nijmengen Medical Centre
Investigators: Professor Nico Verdonschot, Dr Esther Tanck
Stream: PhD
Topic: Upper Limbs (Hip)
Status: Live
Bone metastases occur in about 15% of all cancer cases. Pathological fractures that result from these tumours most frequently occur in the femur (71%). These fractures dramatically affect the terminal patient’s quality of life. Metastatic lesions with a high fracture-risk are mostly surgically treated, whereas low-risk lesions are treated conservatively. However, current methods are inadequate to discriminate between low- and high-risk lesions. Between 42% and 87% of the patients are surgically over-treated, whereas about 14% of the patients, who are defined to be at low-risk, do fracture their bones. The reason for these dissatisfying predictions lays in the fact that it was not yet possible to determine patient’s bone strength in relation to patient’s loading pattern.
The purpose of this project is to improve the prediction of fracture risk in patients with metastatic bone defects in the femur. Therefore, a non-linear computer model will be developed. Goal is to reduce the number of surgically treated patients and the number of fractures at the same time, thereby improving the quality of life of these patients.
Two research phases will be performed. Phase I: development and validation of a predictive computer model to calculate bone strength. For this, laboratory loading experiments and femur-specific computer models (non-linear Finite-Element-Models) will be used and correlated with each other. Phase II: determination of sensitivity and specificity of the predictive model using prospective clinical data. In collaboration with The Dutch Bone Metastasis Study Group, patient-specific Finite-Element-Models will be developed from CT-scans. These models will be virtually exposed to loads from patient’s daily activities, such as walking and stair climbing. To predict fracture risk, the required load to perform the particular activity will be divided by the calculated bone strength of the patient. Once this method is clinically proven, it would be very valuable in the field of osteoporosis as well.
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