Do variations in hip geometry explain differences in hip fracture risk between japanese and white americans?

Nakamura, T.; Turner, Charles H.; Yoshikawa, Tomoaki; Slemenda, Charles W.; Peacock, Munro; Burr, David B.; Mizuno, Yoshifumi; Orimo, Hajime; Ouchi, Yasuyoshi; Johnston, C. Conrad

doi:10.1002/jbmr.5650090715

Cited by 217 publications

(58 citation statements)

References 11 publications

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“…Loss of trabecular bone of the supero-lateral one half of the femoral neck (A-P projection) parallels the higher rates of bone loss seen in the supero-lateral one half of the cortex (represented here by the S, S-A, and S-P sectors) when contrasted to the infero-medial one half. (25,26) Hip fracture cases had no excess of trabecular bone loss beyond that expected to occur through normal aging, confirming our previous results. (27) In consequence, candidates for hip fracture depend on their trabecular bone for more than one half of their s cr , because they suffer a preferential loss of cortical bone that becomes severe with advanced age.…”

Section: Discussionsupporting

confidence: 89%

Femoral Neck Trabecular Bone: Loss With Aging and Role in Preventing Fracture

Thomas¹,

Mayhew

Power

et al. 2009

Journal of Bone and Mineral Research

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Hip fracture risk rises 100-to 1000-fold over six decades of age, but only a minor part of this increase is explained by declining BMD. A potentially independent cause of fragility is cortical thinning predisposing to local crushing, in which bone tissue's material disintegrates at the microscopic level when compressed beyond its capacity to maintain integrity. Elastic instability or buckling of a much thinned cortex might alternatively occur under compression. In a buckle, the cortex moves approximately at right angles to the direction of load, thereby distorting its microstructure, eventually to the point of disintegration. By resisting buckling movement, trabecular buttressing would protect the femoral neck cortex against this type of failure but not against crushing. We quantified the effect of aging on trabecular BMD in the femoral neck and assessed its contribution to cortical elastic stability, which determines resistance to buckling. Using CT, we measured ex vivo the distribution of bone in the midfemoral necks of 35 female and 33 male proximal femurs from cases of sudden death in those 20-95 yr of age. We calculated the critical stress s cr , at which the cortex was predicted to buckle locally, from the geometric properties and density of the cortical zone most highly loaded in a sideways fall. Using long-established engineering principles, we estimated the amount by which stability or buckling resistance was increased by the trabecular bone supporting the most stressed cortical sector in each femoral neck. We repeated these measurements and calculations in an age-and sex-matched series of femoral necks donated by women who had suffered intracapsular hip fracture and controls, using histological measurements of cortical thickness to improve accuracy. With normal aging, trabecular BMD declined asymmetrically, fastest in the supero-lateral one-half (in antero-posterior projection) of the trabecular compartment. When viewed axially with respect to the femoral neck, the most rapid loss of trabecular bone occurred in the posterior part of this region (supero-posterior [S-P]), amounting to a 42% reduction in women (34% in men) over five decades of adult age. Because local cortical bone thickness declined comparably, age had no significant effect on the relative contributions of cortical and trabecular bone to elastic stability, and trabecular bone was calculated to contribute 40% (in men) and 43% (in women) to the S-P cortex of its overall elastic stability. Hip fracture cases had reduced elastic stability compared with agematched controls, with a median reduction of 49% or 37%, depending on whether thickness was measured histologically or by CT (pQCT; p < 0.002 for both). This effect was because of reduced cortical thickness and density. Trabecular BMD was similar in hip fracture cases and controls. The capacity of the femur to resist fracture in a sideways fall becomes compromised with normal aging because cortical thickness and trabecular BMD in the most compressed part of the femoral neck both d...

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Section: Discussionsupporting

confidence: 89%

Femoral Neck Trabecular Bone: Loss With Aging and Role in Preventing Fracture

Thomas¹,

Mayhew

Power

et al. 2009

Journal of Bone and Mineral Research

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“…They found a higher proportion of fractures in women of Asian descent, a factor not controlled for in our study. Nakamura et al found that women of Japanese descent had lower neckshaft angles than white American women, and Japanesedescent women could be an at-risk subset of the population 17 . This stresses the importance of obtaining imaging of both femora in patients with a history of atypical femoral fracture and thigh pain.…”

Section: Discussionmentioning

confidence: 99%

Association of Atypical Femoral Fractures with Bisphosphonate Use by Patients with Varus Hip Geometry

Hagen

Miller

Ott

et al. 2014

The Journal of Bone and Joint Surgery

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“…Among the geometrical parameters, HAL [12][13][14] and NSA [15][16][17] have been under investigation for years in relation to hip fracture, using radiographs and DXA data. It is difficult to maintain a good positioning of the hip joint so as to be able to analyze the geometry using such techniques as HAL and NSA in the radiographs and DXA after hip fracture, since the legs are usually abducted and outwardly rotated 18) .…”

Section: Discussionmentioning

confidence: 99%

Analysis of hip geometry by clinical CT for the assessment of hip fracture risk in elderly Japanese women

Ito

Wakao

Hida

et al. 2010

Bone

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Two case-control studies were designed to investigate the contribution of the geometry and bone mineral density (BMD) of the proximal femur to bone strength in Japanese elderly women. We also investigated whether clinical CT is useful to assess the risk of hip fracture. Subjects in the neck fracture study included 20 Japanese women with neck fracture (age: mean±SD; 80.1±4.5 years old) and 20 age-matched control women was used to analyze data for BMD, geometry, and biomechanical parameters. Both the neck and trochanteric fracture cases had significantly lower total and cortical BMD, a significantly smaller cortical cross-sectional area (CSA) and a larger trabecular CSA.Both had significantly thinner cortex and smaller distance to center of bone mass, and women with trochanteric fracture had a significantly smaller cortical perimeter in the cross-sectional femoral neck. Women with neck fracture had a longer hip axis length (HAL) and women with trochanteric fracture had a significantly larger neck-shaft angle (NSA). Both groups had significantly lower cross-sectional moment of inertia (CSMI), and only women with neck fracture had a significantly higher buckling ratio (BR) compared to their respective controls. According to the multiple logistic regression analysis, women with neck fracture had a significantly longer HAL, lower CSMI, and 3 higher BR, and women with trochanteric fracture had a significantly smaller cortical CSA of the femoral neck. We conclude that clinical CT may be useful for the assessment of the risk of neck and trochanteric fracture.4

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Do variations in hip geometry explain differences in hip fracture risk between japanese and white americans?

Cited by 217 publications

References 11 publications

Femoral Neck Trabecular Bone: Loss With Aging and Role in Preventing Fracture

Femoral Neck Trabecular Bone: Loss With Aging and Role in Preventing Fracture

Association of Atypical Femoral Fractures with Bisphosphonate Use by Patients with Varus Hip Geometry

Analysis of hip geometry by clinical CT for the assessment of hip fracture risk in elderly Japanese women

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