Contribution of the trabecular component to mechanical strength and bone mineral content of the femoral neck. An experimental study on cadaver bones

Werner, C. R.; Iversen, Bjørn Franc; Therkildsen, M. H.

doi:10.1080/00365518809085757

Cited by 35 publications

(15 citation statements)

References 8 publications

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“…Recently, Ferretti et al (1995) have suggested a ''paradigm shift'' away from the traditional view of osteoporosis as a cancellous bone disease, arguing that agerelated fractures begin in the epiphyseal and metaphyseal cortices, rather than the spongiosa. Experimental evidence (Martens et al, 1983;Werner et al, 1988) and finite element models (Lotz et al, 1995) support these contentions and indicate that the cortex carries a substantial portion of the load in the proximal femur, although the contribution of the metaphyseal cortical shell is strongly dependent upon the applied loading conditions (Pinilla et al, 1996). In spite of this, relatively few studies have examined age-related changes in the microstructure or morphology of the metaphyseal cortex in the proximal human femur.…”

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confidence: 73%

Age-related hypermineralization in the female proximal human femur

Vajda

Bloebaum

1999

Anat. Rec.

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Hip fracture incidence increases exponentially with age in virtually every human population that has been studied. In spite of this, relatively few studies have examined age-related changes in the metaphyseal cortex of the proximal femur. The present study investigates cortical aging changes in the female proximal femur, with particular reference to regions of hypermineralization. Thirty-three femora from Caucasian females were obtained at autopsy and analyzed using backscattered electron imaging. Variations in hypermineralized tissue area, cortical bone area, and porosity were quantified with standard stereological methods. Cortical width was quantified with digital calipers. Gender differences were examined by statistical comparison with previously published results. Hypermineralized tissue volume was significantly (P < 0.001) greater in elderly individuals. Hypermineralized tissue preferentially appeared near ligamentous or tendinous insertion sites, suggesting the hypermineralized tissue may be a calcified fibrocartilage. Cortical width significantly (P < 0.001) decreased with age and porosity significantly (P < 0.001) increased with age, however the changes were site-specific. The femoral neck and intertrochanteric cortices had a smaller change in cortical width and porosity with age than the diaphysis, but the femoral neck and intertrochanteric cortices had a larger increase in hypermineralized tissue. Comparison with previous data suggests that cortical aging in the proximal femur is similar between males and females and is unlikely to explain the higher incidence of fracture in females. However, the data strongly indicates that age-related changes in the femoral diaphysis cannot be directly extrapolated to either the femoral neck or intertrochanteric cortices.

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confidence: 73%

Age-related hypermineralization in the female proximal human femur

Vajda

Bloebaum

1999

Anat. Rec.

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“…Some authors have attributed the exponential increase in hip fracture risk with aging to thinning of the cortex of the neck, (24,25) whereas others suggest a synergistic action and a decline in both cortical and trabecular bone. (26)(27)(28) Mechanical testing of excised femoral necks also has given variable results, ranging from cortical contributions of 40% to 60% (14,26) to almost 100% (29) for overall femoral strength. Similarly, finite-element modeling (FEM) has suggested that in the femoral neck region, cortical bone supports 50% of the stresses associated with normal gait or during a fall on the side.…”

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confidence: 99%

In vivo discrimination of hip fracture with quantitative computed tomography: Results from the prospective European Femur Fracture Study (EFFECT)

Bousson

Adams

Engelke³

et al. 2010

Journal of Bone and Mineral Research

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In assessing osteoporotic fractures of the proximal femur, the main objective of this in vivo case-control study was to evaluate the performance of quantitative computed tomography (QCT) and a dedicated 3D image analysis tool [Medical Image Analysis Framework-Femur option (MIAF-Femur)] in differentiating hip fracture and non-hip fracture subjects. One-hundred and seven women were recruited in the study, 47 women (mean age 81.6 years) with low-energy hip fractures and 60 female non-hip fracture control subjects (mean age 73.4 years). Bone mineral density (BMD) and geometric variables of cortical and trabecular bone in the femoral head and neck, trochanteric, and intertrochanteric regions and proximal shaft were assessed using QCT and MIAF-Femur. Areal BMD (aBMD) was assessed using dual-energy X-ray absorptiometry (DXA) in 96 (37 hip fracture and 59 non-hip fracture subjects) of the 107 patients. Logistic regressions were computed to extract the best discriminates of hip fracture, and area under the receiver characteristic operating curve (AUC) was calculated. Three logistic models that discriminated the occurrence of hip fracture with QCT variables were obtained (AUC ¼ 0.84). All three models combined one densitometric variable-a trabecular BMD (measured in the femoral head or in the trochanteric region)-and one geometric variable-a cortical thickness value (measured in the femoral neck or proximal shaft). The best discriminant using DXA variables was obtained with total femur aBMD (AUC ¼ 0.80, p ¼ .003). Results highlight a synergistic contribution of trabecular and cortical components in hip fracture risk and the utility of assessing QCT BMD of the femoral head for improved understanding and possible insights into prevention of hip fractures. ß

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“…In addition to the effect of cancellous bone loss, the role of cortical bone in hip fractures has been recently examined. Both experimental evidence (Werner et al, 1988) and finite element analysis (Lotz et al, 1995) have suggested that the cortex of the femoral neck carries a substantial portion of the load, and thus age-related changes in the morphology and microstructure of the cortex may be a significant contributing factor in hip fractures.…”

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confidence: 99%

Remodeling capacity of calcified fibrocartilage of the hip

Bloebaum

Kopp

2004

Anat. Rec.

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It is well known that the incidence of hip fractures increases exponentially with age and that hip fractures can be a major cause of morbidity and morality among elderly humans; this has prompted substantial research on hip fractures. The majority of research on hip fractures has focused on morphological changes of the proximal femur with age. Recently calcified fibrocartilage in the proximal femur has been shown to increase in fractional area with age and can ultimately make up to 60% of the fractional area of the cortex. However, the capacity of the tissue to remodel and heal is currently unknown. The purpose of the present study was to determine the remodeling capacity of calcified fibrocartilage on the proximal femur compared to the underlying cortical bone. The remodeling capacity of calcified fibrocartilage and cortical bone was assessed in adult female sheep by means of tetracycline labeling. The number of double and single labels within each tissue type was quantified and analyzed with a paired t-test. The data showed very few labels in the calcified fibrocartilage compared to the cortical bone. This indicated that calcified fibrocartilage lacked a capacity to remodel in a manner similar to bone. The results of this investigation demonstrate that while the underlying cortical bone was actively remodeling, the calcified fibrocartilage appeared to have no remodeling capacity similar to that of cortical bone.

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Contribution of the trabecular component to mechanical strength and bone mineral content of the femoral neck. An experimental study on cadaver bones

Cited by 35 publications

References 8 publications

Age-related hypermineralization in the female proximal human femur

Age-related hypermineralization in the female proximal human femur

In vivo discrimination of hip fracture with quantitative computed tomography: Results from the prospective European Femur Fracture Study (EFFECT)

Remodeling capacity of calcified fibrocartilage of the hip

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