Dr G Holzer has served as a speaker for Eli Lilly, Lunar, MSD, Novartis, and sanofi-aventis. All other authors state that they have no conflicts of interest.
Hip Fractures and the Contribution of Cortical Versus Trabecular Bone to Femoral Neck Strength†
Article first published online: 3 NOV 2008
Copyright © 2009 ASBMR
Journal of Bone and Mineral Research
Volume 24, Issue 3, pages 468–474, March 2009
How to Cite
Holzer, G., von Skrbensky, G., Holzer, L. A. and Pichl, W. (2009), Hip Fractures and the Contribution of Cortical Versus Trabecular Bone to Femoral Neck Strength. J Bone Miner Res, 24: 468–474. doi: 10.1359/jbmr.081108
- Issue published online: 4 DEC 2009
- Article first published online: 3 NOV 2008
- Manuscript Accepted: 28 OCT 2008
- Manuscript Revised: 28 AUG 2008
- Manuscript Received: 2 JUL 2008
Osteoporotic fractures are caused by both cortical thinning and trabecular bone loss. Both are seen to be important for bone fragility. The relative contributions of cortical versus trabecular bone have not been established. The aim of this study was to test the contribution of cortical versus trabecular bone to femoral neck stability in bone strength. In one femur from each pair of 18 human cadaver femurs (5 female; 4 male), trabecular bone was completely removed from the femoral neck, providing one bone with intact and the other without any trabecular structure in the femoral neck. Geometrical, X-ray, and DXA measurements were carried out before biomechanical testing (forces to fracture). Femoral necks were osteotomized, slices were analyzed for cross-sectional area (CSA) and cross-sectional moment of inertia (CSMI), and results were compared with biomechanical testing data. Differences between forces needed to fracture excavated and intact femurs (ΔF/F mean) was 7.0% on the average (range, 4.6–17.3%). CSA of removed spongiosa did not correlate with difference of fracture load (ΔF/F mean), nor did BMD. The relative contribution of trabecular versus cortical bone in respect to bone strength in the femoral neck seems to be marginal and seems to explain the subordinate role of trabecular bone and its changes in fracture risk and the effects of treatment options in preventing fractures.