Improved prediction of hip fracture using multi-faceted biomechanical computed tomography
An erratum to this article was published (J Bone Miner Res, 30 Dec 2025 ↗)
Authors' conclusion
We conclude that, compared to both BMD and FRAX, the integrative BCT test better predicted hip fracture and its high sensitivity should improve fracture prevention.
Study context
- Population
- Patients ≥65 yr with an abdominal-pelvic CT during care in a large healthcare system (source population 341,364)validation set
- Participants
- 2,124 patients
- Comparison
- Biomechanical Computed Tomography (BCT) Risk Score vs DXA-equivalent hip BMD T-score vs FRAX hip fracture risk
- Outcome
- Prediction of a first incident hip fracture
- Follow-up
- Within 5 yr
Methodological detailsdevelopment and geographically distinct validation sets, BCT Risk Score developed in 3035 patients (1790 with hip fracture); inputs: age, femoral strength, trabecular/cortical BMD ratio, muscle area, intramuscular fat, FN volume, hip width, posterior fat thickness
- Development and geographically distinct validation sets
- BCT Risk Score developed in 3035 patients (1790 with hip fracture); inputs: age, femoral strength, trabecular/cortical BMD ratio, muscle area, intramuscular fat, FN volume, hip width, posterior fat thickness
Performance
As reported in the abstract
Prediction of first incident hip fracture, women · 5 yr
| Test or model | C-statistic | Sensitivity | PPV |
|---|---|---|---|
| BCT | 0.89 (95% CI 0.87-0.90) | 81.4% | 13.6% |
| BMD | 0.81 (0.79-0.84) | 47.8% | 15.3% |
| FRAX | 0.85 (0.83-0.87) | 75.9% | 12.7% |
C-statistic
BCT0.89 (95% CI 0.87-0.90)
BMD0.81 (0.79-0.84)
FRAX0.85 (0.83-0.87)
Sensitivity
BCT81.4%
BMD47.8%
FRAX75.9%
PPV
BCT13.6%
BMD15.3%
FRAX12.7%
Further findings
Men, 2-yr outcomes and very-high-risk patients
- Similar trends observed
Original publication
Improved prediction of hip fracture using multi-faceted biomechanical computed tomography. J Bone Miner Res. Published 4 October 2025. doi:10.
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