The effects of body mass index and sex on impact force and effective pelvic stiffness during simulated lateral falls

Levine, Iris C.; Bhan, Shivam; Laing, Andrew C.

doi:10.1016/j.clinbiomech.2013.10.002

Cited by 25 publications

(16 citation statements)

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“…The greater stiffness of male hip soft tissues may be an indication of higher muscle content compared to women [50,63,75]. In the other words, if a man and a woman with the same trochanteric soft tissue thickness and the same effective mass experience a sideways fall with the same impact velocity, the applied impact force to the woman's femur is generally lower than that in the male subject [30]. Therefore, the absorbed energy by hip soft tissues in heavy and tall men is not as much as that in women and thus BW and BH in men have stronger effects on the impact force.…”

Section: Resultsmentioning

confidence: 87%

“…There is a slightly positive correlation between BMI and impact force in both sexes (r= 0.25 for men, r= 0.15 for women) that indicates higher BMI subjects are likely to experience a relatively higher impact force, although the correlations were not statistically significant (p N 0.05). Levine et al [30] also reported that the peak impact force in a sideways fall, averaged in both men and women, is 22.6% higher for high-compared to low-BMI subjects.…”

Section: Resultsmentioning

confidence: 93%

“…The second possible reason is the differences in correlations between stiffness/damping properties of the hip soft tissues and STT in men and women. Men with greater BW and BH not only have thinner trochanteric soft tissues than women, their hip soft tissues are also stiffer [30]. The greater stiffness of male hip soft tissues may be an indication of higher muscle content compared to women [50,63,75].…”

Section: Resultsmentioning

confidence: 99%

“…A complex combination of body parameters affects the fall-induced impact force and hip fracture risk [29]. The impact force to the proximal femur increases directly with body weight (BW) [30,31]. BW itself is, in turn, positively associated with trochanteric soft tissue thickness (STT) [32] that is able to considerably attenuate the impact force [10,33].…”

Section: Introductionmentioning

confidence: 99%

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

Nasiri

Luo

2016

Bone

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Section: Resultsmentioning

confidence: 87%

Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Nasiri

Luo

2016

Bone

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

2014

Self Cite

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Fall-related hip injuries are a concern for the growing population of older adults. Evidence suggests that soft tissue overlying the greater trochanter attenuates the forces transmitted to the proximal femur during an impact, reducing mechanical risk of hip fracture. However, there is limited information about the factors that influence trochanteric soft tissue thickness. The current study used ultrasonography and electromyography to determine whether trochanteric soft tissue thickness could be quantified reproducibly and whether it was influenced by: (1) gender; (2) hip postures associated with potential falling configurations in the sagittal plane (from 30° of extension to 60° of flexion, at 15° intervals), combined adduction-flexion, and combined adduction-extension; and (3) activation levels of the tensor fascia lata (TFL) and gluteus medius (GM) muscles. Our results demonstrated that soft tissue thickness can be measured reliably in nine hip postures and three muscle activation conditions (for all conditions, ICC >0.98). Mean (SD) thickness in quiet stance was 2.52 cm. Thickness was 27.0% lower for males than females during quiet stance. It was 16.4% greater at maximum flexion than quiet standing, 27.2% greater at maximum extension, and 12.5% greater during combined adduction-flexion. However, there was no significant difference between combined adduction-extension and quiet standing. Thickness was not affected by changes in muscle activity. Forces applied to the femoral neck during a lateral fall decrease as trochanteric soft tissue thickness increases; gender and postural configuration at impact could influence the loads applied to the proximal femur (and thus hip fracture risk) during falls on the hip.

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Explicit Finite Element Models Accurately Predict Subject-Specific and Velocity-Dependent Kinetics of Sideways Fall Impact

Fleps

Guy

Ferguson

et al. 2019

Journal of Bone and Mineral Research

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The majority of hip fractures in the elderly are the result of a fall from standing or from a lower height. Current injury models focus mostly on femur strength while neglecting subject-specific loading. This article presents an injury modeling strategy for hip fractures related to sideways falls that takes subject-specific impact loading into account. Finite element models (FEMs) of the human body were used to predict the experienced load and the femoral strength in a single model. We validated these models for their predicted peak force, effective pelvic stiffness, and fracture status against matching ex vivo sideways fall impacts (n = 11) with a trochanter velocity of 3.1 m/s. Furthermore, they were compared to sideways impacts of volunteers with lower impact velocities that were previously conducted by other groups. Good agreement was found between the ex vivo experiments and the FEMs with respect to peak force (root mean square error [RMSE] = 10.7%, R 2 = 0.85) and effective pelvic stiffness (R 2 = 0.92, RMSE = 12.9%). The FEMs were predictive of the fracture status for 10 out of 11 specimens. Compared to the volunteer experiments from low height, the FEMs overestimated the peak force by 25% for low BMI subjects and 8% for high BMI subjects. The effective pelvic stiffness values that were derived from the FEMs were comparable to those derived from impacts with volunteers. The force attenuation from the impact surface to the femur ranged between 27% and 54% and was highly dependent on soft tissue thickness (R 2 = 0.86). The energy balance in the FEMS showed that at the time of peak force 79% to 93% of the total energy is either kinetic or was transformed to soft tissue deformation. The presented FEMs allow for direct discrimination between fracture and nonfracture outcome for sideways falls and bridge the gap between impact testing with volunteers and impact conditions representative of real life falls. Specimens: n = 11 (6 female, 5 male). BMI = body mass index (subject weight divided by the subject height squared); T ST,GT = thickness of soft tissue over the greater trochanter; aBMD total hip = areal bone mineral density of the proximal femur.

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The effects of body mass index and sex on impact force and effective pelvic stiffness during simulated lateral falls

Cited by 25 publications

References 42 publications

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

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

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

Explicit Finite Element Models Accurately Predict Subject-Specific and Velocity-Dependent Kinetics of Sideways Fall Impact

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