Femoral neck fragility in women has its structural and biomechanical basis established by periosteal modeling during growth and endocortical remodeling during aging

Silvana Filardi, Roger Martin Djoumessi Zebaze, Yunbo Duan, Jan Edmonds, Thomas Beck, Ego Seeman

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To gain insight into the growth- and age-related origins of bone fragility at the proximal femur, we analyzed structural and biomechanical data of the femoral neck from a study of postmenopausal women with hip fractures and their 47 premenopausal daughters. Results were expressed as standard deviations (SD) or Z-scores (mean ± SEM) adjusted for age and weight, derived using a normal reference population of 262 premenopausal women and 370 postmenopausal women. Women with hip fractures had increased femoral neck (FN) periosteal and endocortical diameters (1.01 ± 0.26 SD and 1.18 ± 0.25 SD, respectively). Cortical thickness was reduced by 0.96 ± 0.1 SD and volumetric bone mineral density (vBMD) was reduced by 1.2 ± 0.1 SD). The section modulus was normal while the buckling ratio was increased by 1.59 ± 0.17 SD). Their daughters had increased FN diameter by about one half that of their mothers (0.48 ± 0.16 SD), while endocortical diameter was increased by only one third (0.44 ± 0.13 SD). Cortical thickness and vBMD were not reduced, the section modulus was increased (0.48 ± 0.13 SD) while the buckling ratio was normal. We infer that the larger femoral neck size in women with hip fractures is growth-related; the wider endocortical cavity and thinner cortex is the result of excessive age-related endocortical bone resorption producing a thin cortex in a larger bone predisposing to structural failure by local buckling. The structural basis of bone fragility has some features originating during growth and others during aging.

Original languageEnglish
Pages (from-to)103-107
Number of pages5
JournalOsteoporosis International
Issue number2
Publication statusPublished - 1 Feb 2004
Externally publishedYes


  • Biomechanical basis
  • Daughters
  • Femoral neck fragility
  • Hip fractures
  • Structural basis

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