Age-dependence of femoral strength in white women and men

Abstract

Although age-related variations in areal bone mineral density (aBMD) and the prevalence of osteoporosis have been well characterized, there is a paucity of data on femoral strength in the population. Addressing this issue, we used finite-element analysis of quantitative computed tomographic scans to assess femoral strength in an age-stratified cohort of 362 women and 317 men, aged 21 to 89 years, randomly sampled from the population of Rochester, MN, and compared femoral strength with femoral neck aBMD. Percent reductions over adulthood were much greater for femoral strength (55% in women, 39% in men) than for femoral neck aBMD (26% in women, 21% in men), an effect that was accentuated in women. Notable declines in strength started in the mid-40s for women and one decade later for men. At advanced age, most of the strength deficit for women compared with men was a result of this decade-earlier onset of strength loss for women, this factor being more important than sex-related differences in peak bone strength and annual rates of bone loss. For both sexes, the prevalence of “low femoral strength” (<3000 N) was much higher than the prevalence of osteoporosis (femoral neck aBMD T-score of −2.5 or less). We conclude that age-related declines in femoral strength are much greater than suggested by age-related declines in femoral neck aBMD. Further, far more of the elderly may be at high risk of hip fracture because of low femoral strength than previously assumed based on the traditional classification of osteoporosis. © 2010 American Society for Bone and Mineral Research

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References 42

1. 1.

   Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. 2004.

   Not in our library

2. 2.

   Cummings SR, Bates D, Black DM. Clinical use of bone densitometry: scientific review. JAMA. 2002;288:1889-1897.

   Not in our library10.1001/jama.288.15.1889 (opens in a new tab)

3. 3.

   Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359:1929-1936.

   Not in our library10.1016/s0140-6736(02)08761-5 (opens in a new tab)

4. 4.

   Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD. Low bone mineral density and fracture burden in postmenopausal women. Can Med Assoc J. 2007;177:575-580.

   Not in our library10.1503/cmaj.070234 (opens in a new tab)

5. 5.

   Pasco JA, Seeman E, Henry MJ, Nicholson GC, Kotowicz MA. The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int. 2006;17:1404-1409.

   Not in our library10.1007/s00198-006-0135-9 (opens in a new tab)

6. 6.

   Stone KL, Seeley DG, Lui LY, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res. 2003;18:1947-1954.

   Not in our library10.1359/jbmr.2003.18.11.1947 (opens in a new tab)

7. 7.

   Wainwright SA, Marshall LM, Ensrud KE, et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. 2005;90:2787-2793.

   Not in our library10.1210/jc.2004-1568 (opens in a new tab)

8. 8.

   Seeman E, Delmas PD. Bone quality: the material and structural basis of bone strength and fragility. N Engl J Med. 2006;354:2250-2261.

   Not in our library10.1056/nejmra053077 (opens in a new tab)

9. 9.

   Kleerekoper M. Osteoporosis prevention and therapy: preserving and building strength through bone quality. Osteoporos Int. 2006;17:1707-1715.

   Not in our library10.1007/s00198-006-0187-x (opens in a new tab)

10. 10.

    Keyak JH. Improved prediction of proximal femoral fracture load using nonlinear finite element models. Med Eng Phys. 2001;23:165-173.

    Not in our library10.1016/s1350-4533(01)00045-5 (opens in a new tab)

11. 11.

    Cody DD, Gross GJ, Hou FJ, Spencer HJ, Goldstein SA, Fyhrie DP. Femoral strength is better predicted by finite element models than QCT and DXA. J Biomech. 1999;32:1013-1020.

    Not in our library10.1016/s0021-9290(99)00099-8 (opens in a new tab)

12. 12.

    Roberts BJ, Kopperdahl DL, Thrall E, Muller JA, Keaveny TM, Bouxsein ML. Prediction of femoral strength in a sideways fall configuration using QCT-based finite element analysis. Bone. 2009;44:S72.

    Not in our library

13. 13.

    Lian KC, Lang TF, Keyak JH, et al. Differences in hip quantitative computed tomography (QCT) measurements of bone mineral density and bone strength between glucocorticoid-treated and glucocorticoid-naive postmenopausal women. Osteoporos Int. 2005;16:642-650.

    Not in our library10.1007/s00198-004-1736-9 (opens in a new tab)

14. 14.

    Keaveny TM, Bouxsein ML. Theoretical implications of the biomechanical fracture threshold. J Bone Miner Res. 2008;23:1541-1547.

    Not in our library10.1359/jbmr.080406 (opens in a new tab)

15. 15.

    Keaveny TM, Hoffmann PF, Singh M, et al. Femoral bone strength and its relation to cortical and trabecular changes after treatment with PTH, alendronate, and their combination as assessed by finite element analysis of quantitative CT scans. J Bone Miner Res. 2008;23:1974-1982.

    Not in our library10.1359/jbmr.080805 (opens in a new tab)

16. 16.

    Lewiecki EM, Keaveny TM, Kopperdahl DL, et al. Once-monthly oral ibandronate improves biomechanical determinants of bone strength in women with postmenopausal osteoporosis. J Clin Endocrinol Metab. 2009;94:171-180.

    Not in our library10.1210/jc.2008-1807 (opens in a new tab)

17. 17.

    Orwoll ES, Marshall LM, Nielson CM, et al. Finite element analysis of the proximal femur and hip fracture risk in older men. J Bone Miner Res. 2009;24:475-483.

    Not in our library10.1359/jbmr.081201 (opens in a new tab)

18. 18.

    Riggs BL, Melton LJ, Robb RA, et al. Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites. J Bone Miner Res. 2004;19:1945-1954.

    Not in our library10.1359/jbmr.040916 (opens in a new tab)

19. 19.

    Melton LJ. History of the Rochester Epidemiology Project. Mayo Clin Proc. 1996;71:266-274.

    Not in our library10.4065/71.3.266 (opens in a new tab)

20. 20.

    Morgan EF, Keaveny TM. Dependence of yield strain of human trabecular bone on anatomic site. J Biomech. 2001;34:569-577.

    Not in our library10.1016/s0021-9290(01)00011-2 (opens in a new tab)

21. 21.

    Morgan EF, Bayraktar HH, Keaveny TM. Trabecular bone modulus-density relationships depend on anatomic site. J Biomech. 2003;36:897-904.

    Not in our library10.1016/s0021-9290(03)00071-x (opens in a new tab)

22. 22.

    Bayraktar HH, Morgan EF, Niebur GL, Morris GE, Wong EK, Keaveny TM. Comparison of the elastic and yield properties of human femoral trabecular and cortical bone tissue. J Biomech. 2004;37:27-35.

    Not in our library10.1016/s0021-9290(03)00257-4 (opens in a new tab)

23. 23.

    Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ, Khaltaev N. A reference standard for the description of osteoporosis. Bone. 2008;42:467-475.

    Not in our library10.1016/j.bone.2007.11.001 (opens in a new tab)

24. 24.

    Bonnick SL. Bone Densitometry in Clinical Practice. 2004.

    Not in our library

25. 25.

    Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8:468-489.

    Not in our library10.1007/s001980050093 (opens in a new tab)

26. 26.

    Bousson V, Le Bras A, Roqueplan F, et al. Volumetric quantitative computed tomography of the proximal femur: relationships linking geometric and densitometric variables to bone strength. Role for compact bone. Osteoporos Int. 2006;17:855-864.

    Not in our library10.1007/s00198-006-0074-5 (opens in a new tab)

27. 27.

    Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett HS, Lipsitz LA. Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int. 1993;52:192-198.

    Not in our library10.1007/bf00298717 (opens in a new tab)

28. 28.

    Nevitt MC, Cummings SR. Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. The Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc. 1993;41:1226-1234.

    Not in our library10.1111/j.1532-5415.1993.tb07307.x (opens in a new tab)

29. 29.

    De Laet CE, van Hout BA, Burger H, Hofman A, Pols HA. Bone density and risk of hip fracture in men and women: cross sectional analysis. BMJ. 1997;315:221-225.

    Not in our library10.1136/bmj.315.7102.221 (opens in a new tab)

30. 30.

    Looker AC, Orwoll ES, Johnston CC, et al. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res. 1997;12:1761-1768.

    Not in our library10.1359/jbmr.1997.12.11.1761 (opens in a new tab)

31. 31.

    Melton LJ, Atkinson EJ, O'Connor MK, O'Fallon WM, Riggs BL. Bone density and fracture risk in men. J Bone Miner Res. 1998;13:1915-1923.

    Not in our library10.1359/jbmr.1998.13.12.1915 (opens in a new tab)

32. 32.

    Melton LJ, Khosla S, Atkinson EJ, O'Connor MK, O'Fallon WM, Riggs BL. Cross-sectional versus longitudinal evaluation of bone loss in men and women. Osteoporos Int. 2000;11:592-599.

    Not in our library10.1007/s001980070080 (opens in a new tab)

33. 33.

    Riggs BL, Melton LJ, Robb RA, et al. A population-based assessment of rates of bone loss at multiple skeletal sites: Evidence for substantial trabecular bone loss in young adult women and men. J Bone Miner Res. 2008;23:205-214.

    Not in our library10.1359/jbmr.071020 (opens in a new tab)

34. 34.

    Lewiecki EM, Miller PD, McClung MR, et al. Two-year treatment with denosumab (AMG 162) in a randomized phase 2 study of postmenopausal women with low BMD. J Bone Miner Res. 2007;22:1832-1841.

    Not in our library10.1359/jbmr.070809 (opens in a new tab)

35. 35.

    Pols HA, Felsenberg D, Hanley DA, et al. Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Fosamax International Trial Study Group. Osteoporos Int. 1999;9:461-468.

    Not in our library10.1007/pl00004171 (opens in a new tab)

36. 36.

    Keaveny TM, Pinilla TP, Crawford RP, Kopperdahl DL, Lou A. Systematic and random errors in compression testing of trabecular bone. J Orthop Res. 1997;15:101-110.

    Not in our library10.1002/jor.1100150115 (opens in a new tab)

37. 37.

    Li W, Kornak J, Harris T, et al. Identify fracture-critical regions inside the proximal femur using statistical parametric mapping. Bone. 2009;44:596-602.

    Not in our library10.1016/j.bone.2008.12.008 (opens in a new tab)

38. 38.

    Marshall LM, Lang TF, Lambert LC, Zmuda JM, Ensrud KE, Orwoll ES. Dimensions and volumetric BMD of the proximal femur and their relation to age among older U.S. men. J Bone Miner Res. 2006;21:1197-1206.

    Not in our library10.1359/jbmr.060506 (opens in a new tab)

39. 39.

    Melton LJ, Marquez MA. Opportunities in population-specific osteoporosis research and management. Osteoporos Int. 2008;19:1679-1681.

    Not in our library10.1007/s00198-008-0673-4 (opens in a new tab)

40. 40.

    Hernandez CJ, Keaveny TM. A biomechanical perspective on bone quality. Bone. 2006;39:1173-1181.

    Not in our library10.1016/j.bone.2006.06.001 (opens in a new tab)

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