Women and men with hip fractures have a longer femoral neck moment arm and greater impact load in a sideways fall

Wang, Q.; Teo, Juin Wei; Ghasem‐Zadeh, Ali; Seeman, Ego

doi:10.1007/s00198-008-0768-y

Cited by 36 publications

(21 citation statements)

References 31 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, both the direct effect of sex steroid deficiency and the indirect effect of the decrease in motor activity appear to contribute to increases in FNAL following ovariectomy. Greater FNAL has been associated with increased risk of fracture independently of age, height, weight, and bone mineral density, which might be related to the fact that a lower force is needed to produce a fracture when the femoral neck moment arm is longer [32]. Notably it has also been suggested that some of the alterations in bone geometry observed following menopause represent compensatory adaptations to counteract the deterioration of bone tissue properties [33].…”

Section: Discussionmentioning

confidence: 97%

Skeletal deterioration following ovarian failure: can some features be a direct consequence of estrogen loss while others are more related to physical inactivity?

et al. 2014

View full text Add to dashboard Cite

Findings on experimental animals show that ovarian failure is accompanied by a decrease in motor activity. As mechanical loading has a vital role in the maintenance of skeletal health, our aim was to determine to what extent this decrease in motor activity contributes to ovariectomy-induced bone loss. Thirty-two female Wistar rats were ovariectomized or sham-operated and housed in standard cages or with access to running wheels for 36 weeks with their running distance monitored. Markers of bone turnover were assayed in the serum, and bone geometry, trabecular and cortical bone microarchitecture, mineralization degree, and biomechanical properties were assessed in the femur. Differences between groups were determined by one-way ANOVA. Although reduced motor activity and sex steroid deficiency both resulted in decreases in trabecular bone volume, trabecular number decreases were mostly associated with sex steroid deficiency, whereas trabecular thickness decreases were mostly associated with sedentary behavior. Cortical bone appeared to be more sensitive to variations in motor activity, whereas bone turnover rate and bone tissue mineralization degree seemed to be primarily affected by sex steroid deficiency, even though they were further aggravated by sedentary behavior. Increases in femur length were mostly a consequence of sex steroid deficiency, whereas femoral neck length was also influenced by sedentary behavior. Differences in mechanical properties resulted mostly from differences in physical activity. Both the direct effect of sex steroid deficiency and the indirect effect of motor activity changes are implicated in bone loss following ovariectomy.

show abstract

Section: Discussionmentioning

confidence: 97%

Skeletal deterioration following ovarian failure: can some features be a direct consequence of estrogen loss while others are more related to physical inactivity?

et al. 2014

View full text Add to dashboard Cite

show abstract

“…In fact, from a biomechanical point of view, the wider the NSA and the longer the HAL, the greater the force absorbed by the proximal femur when falling on the lateral side [26], because of a longer moment arm. Nevertheless, this explanation of the relationship between DXA-measured PFG parameters and hip fracture risk has some limitations.…”

Section: Discussionmentioning

confidence: 99%

Prediction of incident hip fracture by femoral neck bone mineral density and neck–shaft angle: a 5-year longitudinal study in post-menopausal females

Gnudi¹,

Sitta²,

Pignotti³

2012

The British Journal of Radiology

View full text Add to dashboard Cite

Objective: To compare hip fracture incidence in post-menopausal females who were differently stratified for the fracture risk according to bone mineral density and proximal femur geometry. Methods: In a 5 year follow-up study, the hip fracture incidence in 729 postmenopausal females (45 of whom suffered from incident hip fracture) was assessed and compared. Forward logistic regression was used to select independent predictors of hip fracture risk, including age, age at menopause, height, weight, femoral neck bone mineral density (FNBMD), neck-shaft angle (NSA), hip axis length, femoral neck diameter and femoral shaft diameter as covariates. Fracture incidence was then calculated for the categories of young/old age, high/low FNBMD and wide/narrow NSA, which were obtained by dichotomising each hip fracture independent predictor at the value best separating females with and without a hip fracture. Results: The hip fracture incidence of the whole cohort was significantly higher in females with a wide NSA (8.52%) than in those with a narrow NSA (3.51%). The combination of wide NSA and low FNBMD had the highest hip fracture incidence in the whole cohort (17.61%) and each age category. The combinations of narrow/wide NSA with low/high FNBMD, respectively, gave a significantly higher fracture incidence in older than in younger women, whereas women with a combined wide NSA and low FNBMD had no significantly different fracture incidence in young (14.60%) or old age (21.62%). Conclusion: Our study showed that NSA is effective at predicting the hip fracture risk and that the detection in early post-menopause of a wide NSA together with a low FNBMD should identify females at high probability of incident hip fracture.

show abstract

“…This follows the biomechanical concept that the wider the femoral NSA the higher the bending moment at the FN and the higher the impact force imposed on the FN, which results in a greater probability of fracture. 19,21,27,28 Therefore, the ability of NSA to predict hip fracture in males independent of BMD was examined. It was found not only that FN-BMD was the best hip fracture predictor in males but also that NSA does not predict hip fracture independent of FN-BMD.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 This evidence, however, mainly derives from studies carried out in females, 9-13 whereas contradictory results characterize studies carried out in males. [14][15][16][17][18][19][20] Authors' opinions seem to vary widely about the ability of the neck shaft angle (NSA), one of the PFG factors, to predict osteoporotic hip fractures in males, [14][15][16]21 whereas its association with the risk of hip fracture in females 10,11,14,22 is generally accepted. Gender differences in the hip anatomy 23 have been put forward as a possible explanation for the different relationship of NSA with the hip-fracture risk between genders, whereas geographic and racial differences 24 among the examined male populations have been advocated as a possible cause of authors' discrepancies on the relationship between NSA and the hip-fracture risk in males.…”

Section: Advances In Knowledgementioning

confidence: 99%

Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density

Ripamonti¹,

Lisi²,

Avella³

2014

The British Journal of Radiology

View full text Add to dashboard Cite

Objective: To investigate the specificity of the neck shaft angle (NSA) to predict hip fracture in males. Methods: We consecutively studied 228 males without fracture and 38 with hip fracture. A further 49 males with spine fracture were studied to evaluate the specificity of NSA for hip-fracture prediction. Femoral neck (FN) bone mineral density (FN-BMD), NSA, hip axis length and FN diameter (FND) were measured in each subject by dual X-ray absorptiometry. Between-mean differences in the studied variables were tested by the unpaired t-test. The ability of NSA to predict hip fracture was tested by logistic regression. Results: Compared with controls, FN-BMD (p < 0.01) was significantly lower in both groups of males with fractures, whereas FND (p < 0.01) and NSA (p = 0.05) were higher only in the hip-fracture group. A significant inverse correlation (p < 0.01) was found between NSA and FN-BMD. By age-, height- and weight-corrected logistic regression, none of the tested geometric parameters, separately considered from FN-BMD, entered the best model to predict spine fracture, whereas NSA (p < 0.03) predicted hip fracture together with age (p < 0.001). When forced into the regression, FN-BMD (p < 0.001) became the only fracture predictor to enter the best model to predict both fracture types. Conclusion: NSA is associated with hip-fracture risk in males but is not independent of FN-BMD. Advances in knowledge: The lack of ability of NSA to predict hip fracture in males independent of FN-BMD should depend on its inverse correlation with FN-BMD by capturing, as the strongest fracture predictor, some of the effects of NSA on the hip fracture. Conversely, NSA in females does not correlate with FN-BMD but independently predicts hip fractures.

show abstract

Women and men with hip fractures have a longer femoral neck moment arm and greater impact load in a sideways fall

Abstract: A longer moment arm in the sideways fall increases the resultant force applied to the hip predisposing to hip fracture.

Cited by 36 publications

References 31 publications

Skeletal deterioration following ovarian failure: can some features be a direct consequence of estrogen loss while others are more related to physical inactivity?

Skeletal deterioration following ovarian failure: can some features be a direct consequence of estrogen loss while others are more related to physical inactivity?

Prediction of incident hip fracture by femoral neck bone mineral density and neck–shaft angle: a 5-year longitudinal study in post-menopausal females

Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density

Contact Info

Product

Resources

About