Skip to main content
Top
Published in: Osteoporosis International 7/2011

01-07-2011 | Original Article

Differences in femoral neck geometry associated with age and ethnicity

Authors: K. M. Kim, J. K. Brown, K. J. Kim, H. S. Choi, H. N. Kim, Y. Rhee, S.-K. Lim

Published in: Osteoporosis International | Issue 7/2011

Login to get access

Abstract

Summary

We studied femoral geometry in relation to age and ethnicity in a cross-sectional study. Age-associated cortical thinning showed the most pronounced effect, and Koreans studied here had thicker cortices and lower buckling ratios than those reported for other races. Cortical thickness may thus be a major determinant of hip fracture risk.

Introduction

The rate of hip fracture varies by age and ethnicity. The geometric properties of the femur influence femoral strength and fragility, but differences in femoral geometry according to age and ethnicity are poorly understood. To explain the high prevalence of hip fractures in the elderly and the relatively low hip fracture rate in Asian populations, we studied age-related changes and ethnic differences in femoral geometry.

Methods

We recruited 214 peri- or postmenopausal women aged 46 to 85 years (mean age, 60.6 years). Their proximal femoral bone mineral densities (BMD) were measured by quantitative computed tomography and further analyzed geometric properties.

Results

We observed large declines in trabecular volumetric bone mineral density associated with aging (33.03% less than the reference value in the oldest group, respectively). Cortical thickness decreased remarkably with age as well, and only 53.94% of the baseline value remained in the oldest group. As a result, the cortical buckling ratio increased geometrically and reached 239.14% of the reference value in the oldest group. In comparisons with other ethnic groups, Korean subjects had thicker cortices than their American, European, and African counterparts.

Conclusions

In this cross-sectional study, cortical thickness showed a pronounced age-associated decrease, and the cortical buckling ratio showed a strong age-associated increase. This may in part explain the higher rates of hip fractures in the elderly. When compared with other races, Asians had thicker cortical bone and lower buckling ratios, which may partially explain the lower prevalence of hip fractures in Asians.
Appendix
Available only for authorised users
Literature
1.
go back to reference Golden SH, Robinson KA, Saldanha I, Anton B, Ladenson PW (2009) Clinical review: prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab 94:1853–1878PubMedCrossRef Golden SH, Robinson KA, Saldanha I, Anton B, Ladenson PW (2009) Clinical review: prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab 94:1853–1878PubMedCrossRef
2.
go back to reference Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882PubMedCrossRef Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882PubMedCrossRef
3.
go back to reference Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521PubMedCrossRef Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521PubMedCrossRef
4.
go back to reference European Foundation for Osteoporosis Bone Disease, National Osteoporosis Foundation, National Institute of Arthritis and Musculoskeletal and Skin Diseases (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650CrossRef European Foundation for Osteoporosis Bone Disease, National Osteoporosis Foundation, National Institute of Arthritis and Musculoskeletal and Skin Diseases (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650CrossRef
5.
go back to reference Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 4:368–381PubMedCrossRef Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 4:368–381PubMedCrossRef
6.
go back to reference El-Kaissi S, Pasco JA, Henry MJ et al (2005) Femoral neck geometry and hip fracture risk: the Geelong osteoporosis study. Osteoporos Int 16:1299–1303PubMedCrossRef El-Kaissi S, Pasco JA, Henry MJ et al (2005) Femoral neck geometry and hip fracture risk: the Geelong osteoporosis study. Osteoporos Int 16:1299–1303PubMedCrossRef
7.
go back to reference Szulc P, Duboeuf F, Schott AM, Dargent-Molina P, Meunier PJ, Delmas PD (2006) Structural determinants of hip fracture in elderly women: re-analysis of the data from the EPIDOS study. Osteoporos Int 17:231–236PubMedCrossRef Szulc P, Duboeuf F, Schott AM, Dargent-Molina P, Meunier PJ, Delmas PD (2006) Structural determinants of hip fracture in elderly women: re-analysis of the data from the EPIDOS study. Osteoporos Int 17:231–236PubMedCrossRef
8.
go back to reference Kaptoge S, Beck TJ, Reeve J et al (2008) Prediction of incident hip fracture risk by femur geometry variables measured by hip structural analysis in the study of osteoporotic fractures. J Bone Miner Res 23:1892–1904PubMedCrossRef Kaptoge S, Beck TJ, Reeve J et al (2008) Prediction of incident hip fracture risk by femur geometry variables measured by hip structural analysis in the study of osteoporotic fractures. J Bone Miner Res 23:1892–1904PubMedCrossRef
9.
go back to reference Cheng XG, Lowet G, Boonen S et al (1997) Assessment of the strength of proximal femur in vitro: relationship to femoral bone mineral density and femoral geometry. Bone 20:213–218PubMedCrossRef Cheng XG, Lowet G, Boonen S et al (1997) Assessment of the strength of proximal femur in vitro: relationship to femoral bone mineral density and femoral geometry. Bone 20:213–218PubMedCrossRef
10.
go back to reference Alonso CG, Curiel MD, Carranza FH, Cano RP, Perez AD (2000) Femoral bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Multicenter project for research in osteoporosis. Osteoporos Int 11:714–720PubMedCrossRef Alonso CG, Curiel MD, Carranza FH, Cano RP, Perez AD (2000) Femoral bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Multicenter project for research in osteoporosis. Osteoporos Int 11:714–720PubMedCrossRef
11.
go back to reference Center JR, Nguyen TV, Pocock NA, Eisman JA (2004) Volumetric bone density at the femoral neck as a common measure of hip fracture risk for men and women. J Clin Endocrinol Metab 89:2776–2782PubMedCrossRef Center JR, Nguyen TV, Pocock NA, Eisman JA (2004) Volumetric bone density at the femoral neck as a common measure of hip fracture risk for men and women. J Clin Endocrinol Metab 89:2776–2782PubMedCrossRef
12.
go back to reference Siris ES, Chen YT, Abbott TA et al (2004) Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 164:1108–1112PubMedCrossRef Siris ES, Chen YT, Abbott TA et al (2004) Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 164:1108–1112PubMedCrossRef
13.
go back to reference Wainwright SA, Marshall LM, Ensrud KE et al (2005) Hip fracture in women without osteoporosis. J Clin Endocrinol Metab 90:2787–2793PubMedCrossRef Wainwright SA, Marshall LM, Ensrud KE et al (2005) Hip fracture in women without osteoporosis. J Clin Endocrinol Metab 90:2787–2793PubMedCrossRef
14.
go back to reference Lacroix AZ, Beck TJ, Cauley JA et al (2010) Hip structural geometry and incidence of hip fracture in postmenopausal women: what does it add to conventional bone mineral density? Osteoporos Int 21:919–929PubMedCrossRef Lacroix AZ, Beck TJ, Cauley JA et al (2010) Hip structural geometry and incidence of hip fracture in postmenopausal women: what does it add to conventional bone mineral density? Osteoporos Int 21:919–929PubMedCrossRef
15.
go back to reference Hui SL, Slemenda CW, Johnston CC Jr (1988) Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 81:1804–1809PubMedCrossRef Hui SL, Slemenda CW, Johnston CC Jr (1988) Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 81:1804–1809PubMedCrossRef
16.
17.
go back to reference Lau EM, Lee JK, Suriwongpaisal P et al (2001) The incidence of hip fracture in four Asian countries: the Asian osteoporosis study (AOS). Osteoporos Int 12:239–243PubMedCrossRef Lau EM, Lee JK, Suriwongpaisal P et al (2001) The incidence of hip fracture in four Asian countries: the Asian osteoporosis study (AOS). Osteoporos Int 12:239–243PubMedCrossRef
18.
go back to reference Xu L, Lu A, Zhao X, Chen X, Cummings SR (1996) Very low rates of hip fracture in Beijing, People’s Republic of China: the Beijing osteoporosis project. Am J Epidemiol 144:901–907PubMed Xu L, Lu A, Zhao X, Chen X, Cummings SR (1996) Very low rates of hip fracture in Beijing, People’s Republic of China: the Beijing osteoporosis project. Am J Epidemiol 144:901–907PubMed
19.
go back to reference Chang KP, Center JR, Nguyen TV, Eisman JA (2004) Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo osteoporosis epidemiology study. J Bone Miner Res 19:532–536PubMedCrossRef Chang KP, Center JR, Nguyen TV, Eisman JA (2004) Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo osteoporosis epidemiology study. J Bone Miner Res 19:532–536PubMedCrossRef
20.
go back to reference Anderson JY, Trinkaus E (1998) Patterns of sexual, bilateral and interpopulational variation in human femoral neck-shaft angles. J Anat 192:279–285PubMedCrossRef Anderson JY, Trinkaus E (1998) Patterns of sexual, bilateral and interpopulational variation in human femoral neck-shaft angles. J Anat 192:279–285PubMedCrossRef
21.
go back to reference Guermazi A, Mohr A, Grigorian M, Taouli B, Genant HK (2002) Identification of vertebral fractures in osteoporosis. Semin Musculoskelet Radiol 6:241–252PubMedCrossRef Guermazi A, Mohr A, Grigorian M, Taouli B, Genant HK (2002) Identification of vertebral fractures in osteoporosis. Semin Musculoskelet Radiol 6:241–252PubMedCrossRef
22.
go back to reference Rivadeneira F, Zillikens MC, De Laet CE et al (2007) Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam study. J Bone Miner Res 22:1781–1790PubMedCrossRef Rivadeneira F, Zillikens MC, De Laet CE et al (2007) Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam study. J Bone Miner Res 22:1781–1790PubMedCrossRef
23.
go back to reference Nelson DA, Pettifor JM, Barondess DA, Cody DD, Uusi-Rasi K, Beck TJ (2004) Comparison of cross-sectional geometry of the proximal femur in white and black women from Detroit and Johannesburg. J Bone Miner Res 19:560–565PubMedCrossRef Nelson DA, Pettifor JM, Barondess DA, Cody DD, Uusi-Rasi K, Beck TJ (2004) Comparison of cross-sectional geometry of the proximal femur in white and black women from Detroit and Johannesburg. J Bone Miner Res 19:560–565PubMedCrossRef
24.
go back to reference Bell KL, Loveridge N, Power J et al (1999) Structure of the femoral neck in hip fracture: cortical bone loss in the inferoanterior to superoposterior axis. J Bone Miner Res 14:111–119PubMedCrossRef Bell KL, Loveridge N, Power J et al (1999) Structure of the femoral neck in hip fracture: cortical bone loss in the inferoanterior to superoposterior axis. J Bone Miner Res 14:111–119PubMedCrossRef
25.
go back to reference Crabtree N, Loveridge N, Parker M et al (2001) Intracapsular hip fracture and the region-specific loss of cortical bone: analysis by peripheral quantitative computed tomography. J Bone Miner Res 16:1318–1328PubMedCrossRef Crabtree N, Loveridge N, Parker M et al (2001) Intracapsular hip fracture and the region-specific loss of cortical bone: analysis by peripheral quantitative computed tomography. J Bone Miner Res 16:1318–1328PubMedCrossRef
26.
go back to reference Mayhew PM, Thomas CD, Clement JG et al (2005) Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet 366:129–135PubMedCrossRef Mayhew PM, Thomas CD, Clement JG et al (2005) Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet 366:129–135PubMedCrossRef
27.
go back to reference Poole KE, Mayhew PM, Rose CM et al (2009) Changing structure of the femoral neck across the adult female lifespan. J Bone Miner Res 25:482–491CrossRef Poole KE, Mayhew PM, Rose CM et al (2009) Changing structure of the femoral neck across the adult female lifespan. J Bone Miner Res 25:482–491CrossRef
28.
go back to reference Beck TJ, Looker AC, Ruff CB, Sievanen H, Wahner HW (2000) Structural trends in the aging femoral neck and proximal shaft: analysis of the third national health and nutrition examination survey dual-energy X-ray absorptiometry data. J Bone Miner Res 15:2297–2304PubMedCrossRef Beck TJ, Looker AC, Ruff CB, Sievanen H, Wahner HW (2000) Structural trends in the aging femoral neck and proximal shaft: analysis of the third national health and nutrition examination survey dual-energy X-ray absorptiometry data. J Bone Miner Res 15:2297–2304PubMedCrossRef
29.
go back to reference Partanen J, Jms T, Jalovaara P (2001) Influence of the upper femur and pelvic geometry on the risk and type of hip fractures. J Bone Miner Res 16:1540–1546PubMedCrossRef Partanen J, Jms T, Jalovaara P (2001) Influence of the upper femur and pelvic geometry on the risk and type of hip fractures. J Bone Miner Res 16:1540–1546PubMedCrossRef
30.
31.
32.
go back to reference De Laet CE, van Hout BA, Burger H, Hofman A, Pols HA (1997) Bone density and risk of hip fracture in men and women: cross sectional analysis. BMJ 315:221–225PubMed De Laet CE, van Hout BA, Burger H, Hofman A, Pols HA (1997) Bone density and risk of hip fracture in men and women: cross sectional analysis. BMJ 315:221–225PubMed
33.
34.
go back to reference Cummings SR, Cauley JA, Palermo L et al (1994) Racial differences in hip axis lengths might explain racial differences in rates of hip fracture. Study of osteoporotic fractures research group. Osteoporos Int 4:226–229PubMedCrossRef Cummings SR, Cauley JA, Palermo L et al (1994) Racial differences in hip axis lengths might explain racial differences in rates of hip fracture. Study of osteoporotic fractures research group. Osteoporos Int 4:226–229PubMedCrossRef
35.
go back to reference Gregory JS, Aspden RM (2008) Femoral geometry as a risk factor for osteoporotic hip fracture in men and women. Med Eng Phys 30:1275–1286PubMedCrossRef Gregory JS, Aspden RM (2008) Femoral geometry as a risk factor for osteoporotic hip fracture in men and women. Med Eng Phys 30:1275–1286PubMedCrossRef
36.
go back to reference Seeman E (2008) Structural basis of growth-related gain and age-related loss of bone strength. Rheumatol Oxf 47(Suppl 4):iv2–iv8CrossRef Seeman E (2008) Structural basis of growth-related gain and age-related loss of bone strength. Rheumatol Oxf 47(Suppl 4):iv2–iv8CrossRef
37.
go back to reference Bonnick SL, Beck TJ, Cosman F, Hochberg MC, Wang H, de Papp AE (2009) DXA-based hip structural analysis of once-weekly bisphosphonate-treated postmenopausal women with low bone mass. Osteoporos Int 20:911–921PubMedCrossRef Bonnick SL, Beck TJ, Cosman F, Hochberg MC, Wang H, de Papp AE (2009) DXA-based hip structural analysis of once-weekly bisphosphonate-treated postmenopausal women with low bone mass. Osteoporos Int 20:911–921PubMedCrossRef
38.
go back to reference Uusi-Rasi K, Beck TJ, Semanick LM et al (2006) Structural effects of raloxifene on the proximal femur: results from the multiple outcomes of raloxifene evaluation trial. Osteoporos Int 17:575–586PubMedCrossRef Uusi-Rasi K, Beck TJ, Semanick LM et al (2006) Structural effects of raloxifene on the proximal femur: results from the multiple outcomes of raloxifene evaluation trial. Osteoporos Int 17:575–586PubMedCrossRef
39.
go back to reference Pulkkinen P, Partanen J, Jalovaara P, Jamsa T (2004) Combination of bone mineral density and upper femur geometry improves the prediction of hip fracture. Osteoporos Int 15:274–280PubMedCrossRef Pulkkinen P, Partanen J, Jalovaara P, Jamsa T (2004) Combination of bone mineral density and upper femur geometry improves the prediction of hip fracture. Osteoporos Int 15:274–280PubMedCrossRef
40.
go back to reference Kotowicz MA, Melton LJ, Cooper C, Atkinson EJ, O’Fallon WM, Riggs BL (1994) Risk of hip fracture in women with vertebral fracture. J Bone Miner Res 9:599–605PubMedCrossRef Kotowicz MA, Melton LJ, Cooper C, Atkinson EJ, O’Fallon WM, Riggs BL (1994) Risk of hip fracture in women with vertebral fracture. J Bone Miner Res 9:599–605PubMedCrossRef
41.
go back to reference Melton LJ, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221PubMedCrossRef Melton LJ, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221PubMedCrossRef
42.
go back to reference Cano A, Dapa S, Noguera I et al (2008) Comparative effects of 17beta-estradiol, raloxifene and genistein on bone 3D microarchitecture and volumetric bone mineral density in the ovariectomized mice. Osteoporos Int 19:793–800PubMedCrossRef Cano A, Dapa S, Noguera I et al (2008) Comparative effects of 17beta-estradiol, raloxifene and genistein on bone 3D microarchitecture and volumetric bone mineral density in the ovariectomized mice. Osteoporos Int 19:793–800PubMedCrossRef
43.
go back to reference Yeh JK, Chen MM, Aloia JF (1997) Effects of 17 beta-estradiol administration on cortical and cancellous bone of ovariectomized rats with and without hypophysectomy. Bone 20:413–420PubMedCrossRef Yeh JK, Chen MM, Aloia JF (1997) Effects of 17 beta-estradiol administration on cortical and cancellous bone of ovariectomized rats with and without hypophysectomy. Bone 20:413–420PubMedCrossRef
44.
go back to reference Mohamed AM (2003) Bone loss and bone size after menopause. N Engl J Med 349:1671, author reply 1671PubMedCrossRef Mohamed AM (2003) Bone loss and bone size after menopause. N Engl J Med 349:1671, author reply 1671PubMedCrossRef
45.
go back to reference Prevrhal S, Shepherd JA, Faulkner KG, Gaither KW, Black DM, Lang TF (2008) Comparison of DXA hip structural analysis with volumetric QCT. J Clin Densitom 11:232–236PubMedCrossRef Prevrhal S, Shepherd JA, Faulkner KG, Gaither KW, Black DM, Lang TF (2008) Comparison of DXA hip structural analysis with volumetric QCT. J Clin Densitom 11:232–236PubMedCrossRef
46.
go back to reference Khoo BCC, Brown K, Cann C et al (2009) Comparison of QCT-derived and DXA-derived areal bone mineral density and T scores. Osteoporos Int 20:1539–1545PubMedCrossRef Khoo BCC, Brown K, Cann C et al (2009) Comparison of QCT-derived and DXA-derived areal bone mineral density and T scores. Osteoporos Int 20:1539–1545PubMedCrossRef
47.
go back to reference Engelke K, Libanati C, Liu Y et al (2009) Quantitative computed tomography (QCT) of the forearm using general purpose spiral whole-body CT scanners: accuracy, precision and comparison with dual-energy X-ray absorptiometry (DXA). Bone 45:110–118PubMedCrossRef Engelke K, Libanati C, Liu Y et al (2009) Quantitative computed tomography (QCT) of the forearm using general purpose spiral whole-body CT scanners: accuracy, precision and comparison with dual-energy X-ray absorptiometry (DXA). Bone 45:110–118PubMedCrossRef
Metadata
Title
Differences in femoral neck geometry associated with age and ethnicity
Authors
K. M. Kim
J. K. Brown
K. J. Kim
H. S. Choi
H. N. Kim
Y. Rhee
S.-K. Lim
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 7/2011
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-010-1459-z

Other articles of this Issue 7/2011

Osteoporosis International 7/2011 Go to the issue