Hip fractures often occur as a result of bone fragility due to osteoporosis, particularly in the elderly, and have been recognized as a major public health problem given the ever-increasing number of elderly people. In clinics, osteoporosis is often defined in terms of bone mineral density. However, density alone cannot accurately determine bone strength in practice. Many hip fractures occur in people whose hip bone mineral density (BMD) is not severely reduced. Other factors, such as bone geometry, bone internal architecture, and tissue properties, may affect bone strength. Accurate evaluation of hip fracture risk in patients can identify those at high risk so that preventive measures can be taken. It is very important to develop better measures to assess femoral strength and fracture risk using clinically available information. Subject-specific finite element (FE) analysis is a very powerful tool to obtain more sophisticated evaluations of bone strength and the related fracture risk. In this chapter, subject-specific, image-based, nonlinear FE modeling of the proximal femur will be introduced to predict proximal femoral strength and locations of failure.
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