Energy absorption during impact on the proximal femur is affected by body mass index and flooring surface

Study of sex differences in the association between hip fracture risk and body parameters by DXA-based biomechanical modeling

“…The main reason is that the thick layer of trochanteric soft tissues in high BMI women significantly reduces the hip fracture risk by attenuating the applied impact force to the hip [10,64]. Our result that increased BMI in women notably reduces the risk for hip fracture is in a very good agreement with the findings of meta-analyses [34,36] and experimental studies [32,35]. However, the association between BMI and FRI in men (r = −0.13,pN 0.05) is not as strong as it is in women, which is also consistent with the findings of prospective studies [50,91].…”

“…Body height (BH) is also correlated to the impact velocity, and thus the impact severity [31]. In addition, body mass index (BMI) has been identified as a hip fracture risk indicator [32,[34][35][36] which is, in turn, associated with BW, BH, and STT. Apart from the mentioned parameters, BMD, that is commonly used to assess the hip fracture risk in clinics [37][38][39], is inversely correlated to the age of the individual [40][41][42].…”

Factors that influence soft tissue thickness over the greater trochanter: Application to understanding hip fractures

“…We elected to study a young healthy population to align with the participant pool we have previously used to study low-energy sideways falls on the hip Levine et al, 2013;Bhan et al, 2014). Furthermore, the completion of the experimental protocol required a minimum of 46 trials, many of which required standing on one leg or in awkward two-leg positions until a clear image of the uncompressed soft tissue could be obtained.…”

“…Using a finite element model of the femurpelvis system, Majumder et al (2008) demonstrated that an 81% decrease in soft tissue thickness resulted in a 38% increase in peak force and a 97% increase in energy absorption. Within an in vivo-simulated fall paradigm, energy absorption proved to be three times greater in high-BMI fallers than low-BMI fallers (Bhan et al, 2014) and still 1.9 times greater when normalized to body mass, indicating that energy absorption by the trochanteric soft tissues could outpace increases in body mass. These lines of evidence suggest that hip fracture risk is influenced by the trochanteric soft tissues, probably because of their energyabsorptive properties and potential effects on load distribution to the underlying skeletal structures.…”

A two-level subject-specific biomechanical model for improving prediction of hip fracture risk

“…Increases in BMI are typically associated with increased total body and effective mass ( , among our clinical cases), which results in elevated impact loads (Levine et al, 2013). However, body mass index is positively associated with thickness of the soft tissue overlying the greater trochanter which increases the impact energy absorption (Bhan et al, 2014). Relatively high STT in high BMI subjects may underlie the positive but weak association between the BMI and the subject-specific impact force.…”