Individuals with diabetes mellitus type 2 (T2DM) have approximately 30% increased risk of hip fracture; however, the main cause of the elevated fracture risk in those subjects remains unclear. Moreover, micromechanical and microarchitectural properties of the superolateral femoral neck—the common fracture-initiating site—are still unknown. We collected proximal femora of 16 men (eight with T2DM and eight controls; age: 61 ± 10 years) at autopsy. After performing post-mortem bone densitometry (DXA), the superolateral neck was excised and scanned with microcomputed tomography (microCT). We also conducted Vickers microindentation testing. T2DM and control subjects did not differ in age ( p = 0.605), body mass index ( p = 0.114), and femoral neck bone mineral density (BMD) ( p = 0.841). Cortical porosity (Ct.Po) was higher and cortical thickness (Ct.Th) was lower in T2DM ( p = 0.044, p = 0.007, respectively). Of trabecular microarchitectural parameters, only structure model index ( p = 0.022) was significantly different between T2DM subjects and controls. Control group showed higher cortical ( p = 0.002) and trabecular bone microhardness ( p = 0.005). Increased Ct.Po and decreased Ct.Th in T2DM subjects increase the propensity to femoral neck fracture. Apart from the deteriorated cortical microarchitecture, decreased cortical and trabecular microhardness suggests altered bone composition of the superolateral femoral neck cortex and trabeculae in T2DM. Significantly deteriorated cortical microarchitecture of the superolateral femoral neck is not recognized by standard DXA measurement of the femoral neck.

No abstract

Although several studies have analyzed inter-individual differences in the femoral neck cortical microstructure, intra-individual variations have not been comprehensively evaluated. By using microCT, we mapped cortical pore volume fraction (Ct.Po) and thickness (Ct.Th) along the superolateral femoral neck in 14 older women (age: 77.1 ± 9.8 years) to identify subregions and segments with high porosity and/or low thickness—potential “critical” spots where a fracture could start. We showed that Ct.Po and Ct.Th significantly differed between basicervical, midcervical, and subcapital subregions of the femoral neck (p < 0.001), where the subcapital subregion showed the lowest mean Ct.Th and the highest mean Ct.Po. These cortical parameters also varied substantially with age and with the location of the analyzed microsegments along the individual’s neck (p < 0.001), showing multiple microsegments with high porosity and/or low thickness. Although the highest ratio of these microsegments was found in the subcapital subregion, they were also present at other examined subregions, which may provide an anatomical basis for explaining the fracture initiation at various sites of the superolateral neck. Given that fractures likely start at structurally and mechanically weaker spots, intra-individual variability in Ct.Po and Ct.Th should be considered and the average values for the entire femoral neck should be interpreted with caution.

Introduction Here, we present an illustrative case from the Forensic Museum collection made by Professor Milovan Milovanovic (1884-1948). Museum specimen No 465 represents a jar containing three glass syringes and two small bottles of 10-20 ml, sealed with corks, found in the pockets of the deceased whose autopsy was performed in 1929. Case outline It was a 30-year-old male, found dead in the tavern shed, a former medical student, lieutenant, and Russian ?migr? who came to Belgrade in 1921 following commanding General of the anti-Bolshevik White Army, Pyotr Nikolayevich Wrangel. He was an alcoholic, drug user, and a member of the so-called Russian cocaine quartet gang. In the autopsy report, Professor Milovanovic described a textbook example of a drug user: extremely malnourished body, skin covered with scabs, multiple "purulent abscesses" and "livid infiltrations", and attenuated nasal septum with mucosa covered with scabs. Internal autopsy findings included fatty liver, pneumonia, and anemia of all internal organs. At the time, the whole brain, tissue of internal organs, and contents from the stomach and intestines were used for the analysis ("the Stas-Otto method for extraction of alkaloids"). Qualitative analyses showed "the presence of cocaine" in all the examined organs, and the analysis of the content from the "cloudy, colorless liquid" found in the dark bottle showed that it contained "0.0113 g of morphinum-hydrochloricum". Conclusion Contemporary analyses of the material from one of the syringes and the transparent glass bottle performed 90 years later showed the presence of cocaine, morphine, and codeine, confirming that the cause of death was drug-related.