Cortical and trabecular bone in the femoral neck both contribute to proximal femur failure load prediction

• Published in: Osteoporosis international 2009-03, Vol.20 (3), p.445-453
• Main Authors: Manske, S. L, Liu-Ambrose, T, Cooper, D. M. L, Kontulainen, S, Guy, P, Forster, B. B, McKay, H. A
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Bone density; Bone Density - physiology; bone strength; Cadaver; Cortical bone; Diseases of the osteoarticular system; Endocrinology; Female; Femoral neck; Femur Neck - anatomy & histology; Femur Neck - diagnostic imaging; Femur Neck - physiology; Fractures; Hip Fractures - diagnostic imaging; Hip Fractures - pathology; Hip joint; Humans; Legs; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Original Article; Orthopedics; Osteoporosis. Osteomalacia. Paget disease; Proximal femur; QCT; Rheumatology; Stress, Mechanical; Tomography, X-Ray Computed; Trabecular bone
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-008-0675-2

Summary We examined the contributions of femoral neck cortical and trabecular bone to proximal femur failure load. We found that trabecular bone mineral density explained a significant proportion of variance in failure load after accounting for total bone size and cortical bone mineral content or cortical area. Introduction The relative contribution of femoral neck trabecular and cortical bone to proximal femur failure load is unclear. Objectives Our primary objective was to determine whether trabecular bone mineral density (TbBMD) contributes to proximal femur failure load after accounting for total bone size and cortical bone content. Our secondary objective was to describe regional differences in the relationship among cortical bone, trabecular bone, and failure load within a cross-section of the femoral neck. Materials and methods We imaged 36 human cadaveric proximal femora using quantitative computed tomography (QCT). We report total bone area (ToA), cortical area (CoA), cortical bone mineral content (CoBMC), and TbBMD measured in the femoral neck cross-section and eight 45° regions. The femora were loaded to failure. Results and observations Trabecular bone mineral density explained a significant proportion of variance in failure load after accounting for ToA and then either CoBMC or CoA respectively. CoBMC contributed significantly to failure load in all regions of the femoral neck except the posterior region. TbBMD contributed significantly to failure load in all regions of the femoral neck except the inferoanterior, superoposterior, and the posterior regions. Conclusion Both cortical and trabecular bone make significant contributions to failure load in ex vivo measures of bone strength.