Research Papers

Forecasting Postflight Hip Fracture Probability Using Probabilistic Modeling

[+] Author and Article Information
Beth E. Lewandowski, Jerry G. Myers, Jr.

NASA John H. Glenn Research Center,
Low-gravity Exploration Technology Branch,
Cleveland, OH 44135

Manuscript received November 10, 2015; final manuscript received August 7, 2018; published online October 17, 2018. Assoc. Editor: Guy M. Genin. This material is declared a work of the U.S. Government and is not subject to copyright protection in the United States. Approved for public release; distribution is unlimited.

J Biomech Eng 141(1), 011001 (Oct 17, 2018) (10 pages) Paper No: BIO-15-1574; doi: 10.1115/1.4041164 History: Received November 10, 2015; Revised August 07, 2018

A probabilistic model predicts hip fracture probability for postflight male astronauts during lateral fall scenarios from various heights. A biomechanical representation of the hip provides impact load. Correlations relate spaceflight bone mineral density (BMD) loss and postflight BMD recovery to bone strength (BS). Translations convert fracture risk index (FRI), the ratio of applied load (AL) to BS, to fracture probability. Parameter distributions capture uncertainty and Monte Carlo simulations provide probability outcomes. The fracture probability for a 1 m fall 0 days postflight is 15% greater than preflight and remains 6% greater than pre-flight at 365 days postflight. Probability quantification provides insight into how spaceflight induced BMD loss affects fracture probability. A bone loss rate reflecting improved exercise countermeasures and dietary intake further reduces the postflight fracture probability to 6% greater than preflight at 0 days postflight and 2% greater at 365 days postflight. Quantification informs assessments of countermeasure effectiveness. When preflight BMD is one standard deviation below mean astronaut preflight BMD, fracture probability at 0 days postflight is 34% greater than the preflight fracture probability calculated with mean BMD and 28% greater at 365 days postflight. Quantification aids review of astronaut BMD fitness for duty standards. Increases in postflight fracture probability are associated with an estimated 18% reduction in postflight BS. Therefore, a 0.82 deconditioning coefficient modifies force application limits for crew vehicles.

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Grahic Jump Location
Fig. 1

Mass-spring-damper model of the hip. Figure reproduced from Fig. 3(b) in Ref. [6] with permission from Springer Publishing © 2009.

Grahic Jump Location
Fig. 2

The BFxRM bone strength model. Shown are the mean bone strength values for preflight, in-flight and postflight conditions for bone loss rates based upon both the LeBlanc et al. study (solid line) [9] and the Smith et al. study (dashed line) [10].

Grahic Jump Location
Fig. 3

Hip fracture probability distributions for an accidental lateral fall to the side, with no protective reaction from a fall height of 1 m. The mean probably is indicated by the thin solid line and the variance is indicated with the thin dashed lines for preflight conditions (left) and for 0 (center) and 365 (right) days postflight.

Grahic Jump Location
Fig. 4

Mean hip fracture probability for an accidental lateral fall to the side from fall heights ranging from 0 to 2.3 m. Mean probabilities are calculated for preflight conditions (triangles) and for 0 (squares) and 365 (circles) days postflight.

Grahic Jump Location
Fig. 5

Mean hip fracture probability for an accidental lateral fall to the side from heights ranging from 0 to 1.5 m, for two different bone loss rates: (1) the bone loss rate reported in LeBlanc et al., obtained prior to ARED countermeasure use on ISS (squares); (2) the bone loss rate reported in Smith et al., which reflects ARED use and improved nutritional intake (circles). Mean probabilities are calculated for preflight conditions (triangles) and for 0 (left panel) and 365 (right panel) days postflight.

Grahic Jump Location
Fig. 6

Mean hip fracture probability for an accidental lateral fall to the side from heights ranging from 0 to 1.5, for two different preflight BMD levels: 1) mean preflight BMD (0.808 gcm−2) (triangles); 2) preflight BMD one standard deviation below the mean (0.705 gcm−2) (squares). Probabilities are calculated for preflight conditions and for 0 and 365 days postflight.



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