Osteoporosis International

, Volume 28, Issue 10, pp 2759–2780 | Cite as

Sideways fall-induced impact force and its effect on hip fracture risk: a review

  • M. Nasiri Sarvi
  • Y. Luo



Osteoporotic hip fracture, mostly induced in falls among the elderly, is a major health burden over the world. The impact force applied to the hip is an important factor in determining the risk of hip fracture. However, biomechanical researches have yielded conflicting conclusions about whether the fall-induced impact force can be accurately predicted by the available models. It also has been debated whether or not the effect of impact force has been considered appropriately in hip fracture risk assessment tools. This study aimed to provide a state-of-the-art review of the available methods for predicting the impact force, investigate their strengths/limitations, and suggest further improvements in modeling of human body falling.


We divided the effective parameters on impact force to two categories: (1) the parameters that can be determined subject-specifically and (2) the parameters that may significantly vary from fall to fall for an individual and cannot be considered subject-specifically.


The parameters in the first category can be investigated in human body fall experiments. Video capture of real-life falls was reported as a valuable method to investigate the parameters in the second category that significantly affect the impact force and cannot be determined in human body fall experiments.


The analysis of the gathered data revealed that there is a need to develop modified biomechanical models for more accurate prediction of the impact force and appropriately adopt them in hip fracture risk assessment tools in order to achieve a better precision in identifying high-risk patients.

Graphical abstract

Impact force to the hip induced in sideways falls is affected by many parameters and may remarkably vary from subject to subject


Fall Fracture risk Hip Hip fracture Impact force Sideways 


Compliance with ethical standards

Conflicts of interest


Supplementary material

198_2017_4138_MOESM1_ESM.pdf (121 kb)
Supplementary Fig. 1 (PDF 120 kb)
198_2017_4138_MOESM2_ESM.pdf (120 kb)
Supplementary Fig. 2 (PDF 119 kb)
198_2017_4138_MOESM3_ESM.pdf (112 kb)
Supplementary Fig. 3 (PDF 112 kb)
198_2017_4138_MOESM4_ESM.pdf (122 kb)
Supplementary Fig. 4 (PDF 121 kb)


  1. 1.
    DeGoede KM, Ashton-Miller JA, Schultz AB (2003) Fall-related upper body injuries in the older adult: a review of the biomechanical issues. J Biomech 36:1043–1053PubMedCrossRefGoogle Scholar
  2. 2.
    Rivara FP, Grossman DC, Cummings P (1997) Injury prevention. N Engl J Med 337:543–548PubMedCrossRefGoogle Scholar
  3. 3.
    Green C, Molony D, Fitzpatrick C, ORourke K (2010) Age-specific incidence of hip fracture in the elderly: a healthy decline. Surgeon 8:310–313PubMedCrossRefGoogle Scholar
  4. 4.
    Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413PubMedCrossRefGoogle Scholar
  5. 5.
    Kannus P, Leiponen P, Parkkari J, Palvanen M, Jarvinen M (2006) A sideways fall and hip fracture. Bone 39:383–384PubMedCrossRefGoogle Scholar
  6. 6.
    Boonen S, Autier P, Barette M, Vanderschueren D, Lips P, Haentjens P (2004) Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporos Int 15:87–94PubMedCrossRefGoogle Scholar
  7. 7.
    Phillips S, Fox N, Jacobs J, Wright WE (1988) The direct medical costs of osteoporosis for American women aged 45 and older. Bone 9:271–279PubMedCrossRefGoogle Scholar
  8. 8.
    Huddleston JM, Whitford KJ (2001) Medical care of elderly patients with hip fractures. Mayo Clin Proc 76:295–298PubMedCrossRefGoogle Scholar
  9. 9.
    Greenspan SL, Myers ER, Kiel DP, Parker RA, Hayes WC, Resnick NM (1998) Fall direction, bone mineral density, and function: risk factors for hip fracture in frail nursing home elderly. Am J Med 104:539–545PubMedCrossRefGoogle Scholar
  10. 10.
    Hayes WC, Piazza SJ, Zysset PK (1991) Biomechanics of fracture risk prediction of the hip and spine by quantitative computed tomography. Radiol Clin N Am 29:1–18PubMedGoogle Scholar
  11. 11.
    Myers ER, Wilson SE (1997) Biomechanics of osteoporosis and vertebral fracture. Spine 22:25S–31SPubMedCrossRefGoogle Scholar
  12. 12.
    Luo Y (2015) A biomechanical sorting of clinical risk factors affecting osteoporotic hip fracture. Osteoporosis International 1-17Google Scholar
  13. 13.
    Robinovitch SN, Hayes WC, McMahon TA (1991) Prediction of femoral impact forces in falls on the hip. ASME J Biomech Eng 113:366–374CrossRefGoogle Scholar
  14. 14.
    Kroonenberg AJ, Hayes WC, McMahon TA (1995) Dynamic models for sideways falls from standing height. J Biomech Eng 117:309–318PubMedCrossRefGoogle Scholar
  15. 15.
    Robinovitch SN, McMahon TA, Hayes WC (1995) Force attenuation in trochanteric soft tissues during impact from a fall. J Orthop Res 13:956–962PubMedCrossRefGoogle Scholar
  16. 16.
    Van den Kroonenberg AJ, Hayes WC, McMahon TA (1996) Hip impact velocities and body configurations for voluntary falls from standing height. J Biomech 29:807–811PubMedCrossRefGoogle Scholar
  17. 17.
    Hayes WC, Myers ER, Robinovitch SN, Van Den Kroonenberg A, Courtney AC, McMahon TA (1996) Etiology and prevention of age-related hip fractures. Bone 18:S77–S86CrossRefGoogle Scholar
  18. 18.
    Robinovitch SN, Hayes WC, McMahon TA (1997) Distribution of contact force during impact to the hip. Ann Biomed Eng 25:499–508PubMedCrossRefGoogle Scholar
  19. 19.
    Robinovitch SN, Hayes WC, McMahon TA (1997) Predicting the impact response of a nonlinear single-degree-of-freedom shock-absorbing system from the measured step response. J Biomech Eng 119:221–227PubMedCrossRefGoogle Scholar
  20. 20.
    Sandler R, Robinovitch S (2001) An analysis of the effect of lower extremity strength on impact severity during a backward fall. J Biomech Eng 123:590–598PubMedCrossRefGoogle Scholar
  21. 21.
    Robinovitch SN, Inkster L, Maurer J, Warnick B (2003) Strategies for avoiding hip impact during sideways falls. J Bone Miner Res 18:1267–1273PubMedCrossRefGoogle Scholar
  22. 22.
    Robinovitch SN, Brumer R, Maurer J (2004) Effect of the squat protective response on impact velocity during backward falls. J Biomech 37:1329–1337PubMedCrossRefGoogle Scholar
  23. 23.
    Feldman F, Robinovitch SN (2007) Reducing hip fracture risk during sideways falls: evidence in young adults of the protective effects of impact to the hands and stepping. J Biomech 40:2612–2618PubMedCrossRefGoogle Scholar
  24. 24.
    Laing AC, Robinovitch SN (2010) Characterizing the effective stiffness of the pelvis during sideways falls on the hip. J Biomech 43:1898–1904PubMedCrossRefGoogle Scholar
  25. 25.
    Levine IC, Bhan S, Laing AC (2013) The effects of body mass index and sex on impact force and effective pelvic stiffness during simulated lateral falls. Clin Biomech 28:1026–1033CrossRefGoogle Scholar
  26. 26.
    Choi WJ, Cripton PA, Robinovitch SN (2015) Effects of hip abductor muscle forces and knee boundary conditions on femoral neck stresses during simulated falls. Osteoporos Int 26:291–301PubMedCrossRefGoogle Scholar
  27. 27.
    Nasiri M, Luo Y (2016) Study of sex differences in the association between hip fracture risk and body parameters by DXA-based biomechanical modeling. Bone 90:90–98PubMedCrossRefGoogle Scholar
  28. 28.
    Laing AC, Tootoonchi I, Hulme PA, Robinovitch SN (2006) Effect of compliant flooring on impact force during falls on the hip. J Orthop Res 24:1405–1411PubMedCrossRefGoogle Scholar
  29. 29.
    Bateni H, Zecevic A, McIlroy W, Maki B (2004) Resolving conflicts in task demands during balance recovery: does holding an object inhibit compensatory grasping? Exp Brain Res 157:49–58PubMedCrossRefGoogle Scholar
  30. 30.
    Smith LD (1953) Hip fractures: the role of muscle contraction or intrinsic forces in the causation of fractures of the femoral neck. J Bone Joint Surg 35:367–383PubMedCrossRefGoogle Scholar
  31. 31.
    Phillips J, Williams J, Melick R (1975) Prediction of the strength of the neck of femur from its radiological appearance. Biomed Eng 10:367–372PubMedGoogle Scholar
  32. 32.
    Dalen N, Hellstrom L, Jacobson B (1976) Bone mineral content and mechanical strength of the femoral neck. Acta Orthop Scand 47:503–508PubMedCrossRefGoogle Scholar
  33. 33.
    Leichter I, Margulies JY, Weinreb A, Mizrahi J, Robin GC, Conforty B, Makin M, Bloch B (1982) The relationship between bone density, mineral content, and mechanical strength in the femoral neck. Clin Orthop Relat Res 163:272–281Google Scholar
  34. 34.
    Mizrahi J, Margulies JY, Leichter I, Deutsch D (1984) Fracture of the human femoral neck: effect of density of the cancellous core. J Biomed Eng 6:56–62PubMedCrossRefGoogle Scholar
  35. 35.
    Alho A, Husby T, Hoiseth A (1988) Bone mineral content and mechanical strength an ex vivo study on human femora at autopsy. Clin Orthop Relat Res 227:292–297PubMedGoogle Scholar
  36. 36.
    Esses S, Lotz J, Hayes W (1989) Biomechanical properties of the proximal femur determined in vitro by single-energy quantitative computed tomography. J Bone Miner Res 4:715–722PubMedCrossRefGoogle Scholar
  37. 37.
    Lotz JC, Hayes WC (1990) The use of quantitative computed tomography to estimate risk of fracture of the hip from falls. J Bone Joint Surg 72:689–700PubMedCrossRefGoogle Scholar
  38. 38.
    Courtney AC, Wachtel EF, Myers ER, Hayes WC (1994) Effects of loading rate on strength of the proximal femur. Calcif Tissue Int 55:53–58PubMedCrossRefGoogle Scholar
  39. 39.
    Bouxsein ML, Courtney AC, Hayes WC (1995) Ultrasound and densitometry of the calcaneus correlate with the failure loads of cadaveric femurs. Calcif Tissue Int 56:99–103PubMedCrossRefGoogle Scholar
  40. 40.
    Pinilla T, Boardman K, Bouxsein M, Myers E, Hayes W (1996) Impact direction from a fall influences the failure load of the proximal femur as much as age-related bone loss. Calcif Tissue Int 58:231–235PubMedCrossRefGoogle Scholar
  41. 41.
    Cheng XG, Lowet G, Boonen S, Nicholson PHF, Brys P, Nijs J, Dequeker J (1997) Assessment of the strength of proximal femur in vitro: relationship to femoral bone mineral density and femoral geometry. Bone 20:213–218PubMedCrossRefGoogle Scholar
  42. 42.
    Cheng XG, Lowet G, Boonen S, Nicholson PHF, Van Der Perre G, Dequeker J (1998) Prediction of vertebral and femoral strength in vitro by bone mineral density measured at different skeletal sites. J Bone Miner Res 13:1439–1443PubMedCrossRefGoogle Scholar
  43. 43.
    Lang TF, Keyak JH, Heitz MW, Augat P, Lu Y, Mathur A, Genant HK (1997) Volumetric quantitative computed tomography of the proximal femur: precision and relation to bone strength. Bone 21:101–108PubMedCrossRefGoogle Scholar
  44. 44.
    Keyak JH, Rossi SA, Jones KA, Skinner HB (1998) Prediction of femoral fracture load using automated finite element modeling. J Biomech 31:125–133PubMedCrossRefGoogle Scholar
  45. 45.
    Bouxsein ML, Coan BS, Lee SC (1999) Prediction of the strength of the elderly proximal femur by bone mineral density and quantitative ultrasound measurements of the heel and tibia. Bone 25:49–54PubMedCrossRefGoogle Scholar
  46. 46.
    Keyak JH (2000) Relationships between femoral fracture loads for two load configurations. J Biomech 33:499–502PubMedCrossRefGoogle Scholar
  47. 47.
    Lochmuller EM, Groll O, Kuhn V, Eckstein F (2002) Mechanical strength of the proximal femur as predicted from geometric and densitometric bone properties at the lower limb versus the distal radius. Bone 30:207–216PubMedCrossRefGoogle Scholar
  48. 48.
    Eckstein F, Wunderer C, Boehm H, Kuhn V, Priemel M, Link TM, Lochmüller E-M (2004) Reproducibility and side differences of mechanical tests for determining the structural strength of the proximal femur. J Bone Miner Res 19:379–385PubMedCrossRefGoogle Scholar
  49. 49.
    Heini PF, Franz T, Fankhauser C, Gasser B, Ganz R (2004) Femoroplasty-augmentation of mechanical properties in the osteoporotic proximal femur: a biomechanical investigation of PMMA reinforcement in cadaver bones. Clin Biomech 19:506–512CrossRefGoogle Scholar
  50. 50.
    Manske SL, Liu-Ambrose T, de Bakker PM, Liu D, Kontulainen S, Guy P, Oxland TR, McKay HA (2006) Femoral neck cortical geometry measured with magnetic resonance imaging is associated with proximal femur strength. Osteoporos Int 17:1539–1545PubMedCrossRefGoogle Scholar
  51. 51.
    Pulkkinen P, Eckstein F, Lochmüller E-M, Kuhn V, Jämsä T (2006) Association of geometric factors and failure load level with the distribution of cervical vs. trochanteric hip fractures. J Bone Min Res 21:895–901CrossRefGoogle Scholar
  52. 52.
    Pulkkinen P, Jämsä T, Lochmüller EM, Kuhn V, Nieminen MT, Eckstein F (2008) Experimental hip fracture load can be predicted from plain radiography by combined analysis of trabecular bone structure and bone geometry. Osteoporos Int 19:547–558PubMedCrossRefGoogle Scholar
  53. 53.
    Langton CM, Pisharody S, Keyak JH (2009) Comparison of 3D finite element analysis derived stiffness and BMD to determine the failure load of the excised proximal femur. Med Eng Phys 31:668–672PubMedCrossRefGoogle Scholar
  54. 54.
    de Bakker PM, Manske SL, Ebacher V, Oxland TR, Cripton PA, Guy P (2009) During sideways falls proximal femur fractures initiate in the superolateral cortex: evidence from high-speed video of simulated fractures. J Biomech 42:1917–1925PubMedCrossRefGoogle Scholar
  55. 55.
    Dragomir D, Buijs J, McEligot S, Dai Y, Entwistle R, Salas C, Melton L, Bennet K, Khosla S, Amin S (2011) Robust QCT/FEA models of proximal femur stiffness and fracture load during a sideways fall on the hip. Ann Biomed Eng 39:742–755CrossRefGoogle Scholar
  56. 56.
    Buijs J, Dragomir D (2011) Validated finite element models of the proximal femur using two-dimensional projected geometry and bone density. Comput Methods Prog Biomed 104:168–174CrossRefGoogle Scholar
  57. 57.
    Koivumaki J, Thevenot J, Pulkkinen P, Kuhn V, Link TM, Eckstein F, Jamsa T (2012) CT-based finite element models can be used to estimate experimentally measured failure loads in the proximal femur. Bone 50:824–829PubMedCrossRefGoogle Scholar
  58. 58.
    Koivumaki JEM, Thevenot J, Pulkkinen P, Kuhn V, Link TM, Eckstein F, Jamsa T (2012) Cortical bone finite element models in the estimation of experimentally measured failure loads in the proximal femur. Bone 51:737–740PubMedCrossRefGoogle Scholar
  59. 59.
    Nishiyama KK, Gilchrist S, Guy P, Cripton P, Boyd SK (2013) Proximal femur bone strength estimated by a computationally fast finite element analysis in a sideways fall configuration. J Biomech 46:1231–1236PubMedCrossRefGoogle Scholar
  60. 60.
    Dall'Ara E, Luisier B, Schmidt R, Kainberger F, Zysset P, Pahr D (2013) A nonlinear QCT-based finite element model validation study for the human femur tested in two configurations in vitro. Bone 52:27–38PubMedCrossRefGoogle Scholar
  61. 61.
    Mirzaei M, Keshavarzian M, Naeini V (2014) Analysis of strength and failure pattern of human proximal femur using quantitative computed tomography (QCT)-based finite element method. Bone 64:108–114PubMedCrossRefGoogle Scholar
  62. 62.
    Gilchrist S, Nishiyama KK, de Bakker P, Guy P, Boyd SK, Oxland T, Cripton PA (2014) Proximal femur elastic behaviour is the same in impact and constant displacement rate fall simulation. J Biomech 47:3744–3749PubMedCrossRefGoogle Scholar
  63. 63.
    Ariza O, Gilchrist S, Widmer RP, Guy P, Ferguson SJ, Cripton PA, Helgason B (2015) Comparison of explicit finite element and mechanical simulation of the proximal femur during dynamic drop-tower testing. J Biomech 48:224–232PubMedCrossRefGoogle Scholar
  64. 64.
    Grassi L, Väänänen SP, Ristinmaa M, Jurvelin JS, Isaksson H (2016) How accurately can subject-specific finite element models predict strains and strength of human femora? Investigation using full-field measurements. J Biomech 49:802–806PubMedCrossRefGoogle Scholar
  65. 65.
    Grassi L, Väänänen SP, Ristinmaa M, Jurvelin JS, Isaksson H (2016) Prediction of femoral strength using 3D finite element models reconstructed from DXA images: validation against experiments. Biomechanics and Modeling in Mechanobiology 1-12Google Scholar
  66. 66.
    Robinovitch SN, Evans SL, Minns J et al (2009) Hip protectors: recommendations for biomechanical testing-an international consensus statement (part I). Osteoporos Int 20:1977–1988PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Haider IT, Speirs AD, Frei H (2013) Effect of boundary conditions, impact loading and hydraulic stiffening on femoral fracture strength. J Biomech 46:2115–2121PubMedCrossRefGoogle Scholar
  68. 68.
    Weber T, Yang K, Woo R, Fitzgerald R (1992) Proximal femur strength: correlation of the rate of loading and bone mineral density. ASME Adv Bioeng BED 22:111–114Google Scholar
  69. 69.
    Beck TJ, Ruff CB, Warden KE, Scott WW Jr, Rao GU (1990) Predicting femoral neck strength from bone mineral data: a structural approach. Investig Radiol 25:6–18CrossRefGoogle Scholar
  70. 70.
    Kanis J, McCloskey E, Johansson H, Oden A, Borgstrom F, Strom O (2010) Development and use of FRAX in osteoporosis. Osteoporos Int 21:407–413CrossRefGoogle Scholar
  71. 71.
    Brekelmans WAM, Poorth HW, Slooff TJJH (1972) A new method to analyse the mechanical behaviour of skeletal parts. Acta orthop Scandinav 43:301–317CrossRefGoogle Scholar
  72. 72.
    Nielson C, Bouxsein M, Freitas S, Ensrud K, Orwoll E (2009) Trochanteric soft tissue thickness and hip fracture in older men. J Clin Endocrinol Metab 94:491–496PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Blaak E (2001) Gender differences in fat metabolism. Curr Opin Clin Nutr Metab Care 4:499–502PubMedCrossRefGoogle Scholar
  74. 74.
    Robinovitch SN, Feldman F, Yang Y, Schonnop R, Leung PM, Sarraf T, Sims-Gould J, Loughin M (2013) Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. Lancet 381:47–54PubMedCrossRefGoogle Scholar
  75. 75.
    Nasiri Sarvi M (2015) Assessment of hip fracture risk by a two-level subject-specific biomechanical model. Mechanical Engineering. Ph.D. thesis, University of Manitoba, Canada, p 164Google Scholar
  76. 76.
    Groen BE, Weerdesteyn V, Duysens J (2007) Martial arts fall techniques decrease the impact forces at the hip during sideways falling. J Biomech 40:458–462PubMedCrossRefGoogle Scholar
  77. 77.
    Nasiri Sarvi M, Luo Y (2015) A two-level subject-specific biomechanical model for improving prediction of hip fracture risk. Clin Biomech 30:881–887CrossRefGoogle Scholar
  78. 78.
    Nasiri Sarvi M, Luo Y, Sun P, Ouyang J (2014) Experimental validation of subject-specific dynamics model for predicting impact force in sideways fall. J Biomed Sci Eng 7:405–418CrossRefGoogle Scholar
  79. 79.
    Pena E, Calvo B, Martinez MA, Doblare M (2007) An anisotropic visco-hyperelastic model for ligaments at finite strains. Formulation and computational aspects. Int J Solids Struct 44:760–778CrossRefGoogle Scholar
  80. 80.
    Majumder S, Roychowdhury A, Pal S (2008) Effects of trochanteric soft tissue thickness and hip impact velocity on hip fracture in sideways fall through 3D finite element simulations. J Biomech 41:2834–2842PubMedCrossRefGoogle Scholar
  81. 81.
    Natali AN, Carniel EL, Pavan PG (2008) Constitutive modelling of inelastic behaviour of cortical bone. Med Eng Phys 30:905–912PubMedCrossRefGoogle Scholar
  82. 82.
    Malmivaara A, Heliovaara M, Knekt P, Reunanen A, Aromaa A (1993) Risk factors for injurious falls leading to hospitalization or death in a cohort of 19,500 adults. Am J Epidemiol 138:384–394PubMedCrossRefGoogle Scholar
  83. 83.
    Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC (1994) Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA 271:128–133PubMedCrossRefGoogle Scholar
  84. 84.
    Laet C, Kanis JA, Oden A et al (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338PubMedCrossRefGoogle Scholar
  85. 85.
    Bouxsein ML, Szulc P, Munoz F, Thrall E, Sornay-Rendu E, Delmas PD (2007) Contribution of trochanteric soft tissues to fall force estimates, the factor of risk, and prediction of hip fracture risk. J Bone Miner Res 22:825–831PubMedCrossRefGoogle Scholar
  86. 86.
    Armstrong MEG, Spencer EA, Cairns BJ, Banks E, Pirie K, Green J, Wright FL, Reeves GK, Beral V, for the Million Women Study C (2011) Body mass index and physical activity in relation to the incidence of hip fracture in postmenopausal women. J Bone Miner Res 26:1330–1338PubMedCrossRefGoogle Scholar
  87. 87.
    Johansson H, Kanis JA, Odén A et al (2013) A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 29:223–233CrossRefGoogle Scholar
  88. 88.
    Majumder S, Roychowdhury A, Pal S (2013) Hip fracture and anthropometric variations: dominance among trochanteric soft tissue thickness, body height and body weight during sideways fall. Clin Biomech 28:1034–1040CrossRefGoogle Scholar
  89. 89.
    Bhan S, Levine IC, Laing AC (2014) Energy absorption during impact on the proximal femur is affected by body mass index and flooring surface. J Biomech 47:2391–2397PubMedCrossRefGoogle Scholar
  90. 90.
    Choi WJ, Russell CM, Tsai CM, Arzanpour S, Robinovitch SN (2015) Age-related changes in dynamic compressive properties of trochanteric soft tissues over the hip. J Biomech 48:695–700PubMedCrossRefGoogle Scholar
  91. 91.
    Derler S, Spierings AB, Schmitt KU (2005) Anatomical hip model for the mechanical testing of hip protectors. Med Eng Phys 27:475–485PubMedCrossRefGoogle Scholar
  92. 92.
    Li N, Tsushima E, Tsushima H (2013) Comparison of impact force attenuation by various combinations of hip protector and flooring material using a simplified fall-impact simulation device. J Biomech 46:1140–1146PubMedCrossRefGoogle Scholar
  93. 93.
    Laing AC, Robinovitch SN (2008) The force attenuation provided by hip protectors depends on impact velocity, pelvic size, and soft tissue stiffness. Journal of Biomechanical Engineering 130:Google Scholar
  94. 94.
    Laing AC, Robinovitch SN (2008) Effect of soft shell hip protectors on pressure distribution to the hip during sideways falls. Osteoporos Int 19:1067–1075PubMedCrossRefGoogle Scholar
  95. 95.
    Choi WJ, Hoffer JA, Robinovitch SN (2010) Effect of hip protectors, falling angle and body mass index on pressure distribution over the hip during simulated falls. Clin Biomech 25:63–69CrossRefGoogle Scholar
  96. 96.
    Luo Y, Nasiri Sarvi M, Sun P, Leslie WD, Ouyang J (2014) Prediction of impact force in sideways fall by image-based subject-specific dynamics model. International Biomechanics 1-14Google Scholar
  97. 97.
    Durkin JL, Dowling JJ, Andrews DM (2002) The measurement of body segment inertial parameters using dual energy X-ray absorptiometry. J Biomech 35:1575–1580PubMedCrossRefGoogle Scholar
  98. 98.
    Luo Y, Nasiri Sarvi M (2015) A subject-specific inverse-dynamics approach for estimating joint stiffness in sideways fall. Int J Exp Comput Biomech 3:137–160CrossRefGoogle Scholar
  99. 99.
    Lo J, Ashton-Miller JA (2008) Effect of pre-impact movement strategies on the impact forces resulting from a lateral fall. J Biomech 41:1969–1977PubMedPubMedCentralCrossRefGoogle Scholar
  100. 100.
    DeGoede KM, Ashton-Miller JA (2002) Fall arrest strategy affects peak hand impact force in a forward fall. J Biomech 35:843–848PubMedCrossRefGoogle Scholar
  101. 101.
    Yoshikawa T, Turner CH, Peacock M, Slemenda CW, Weaver CM, Teegarden D, Markwardt P, Burr DB (1994) Geometric structure of the femoral neck measured using dual-energy X-ray absorptiometry. J Bone Miner Res 9:1053–1064PubMedCrossRefGoogle Scholar
  102. 102.
    Hayes W, Myers E, Morris J, Gerhart T, Yett H, Lipsitz L (1993) Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int 52:192–198PubMedCrossRefGoogle Scholar
  103. 103.
    Cc S, Hayes WC, McMahon TA (2001) Disturbance type and gait speed affect fall direction and impact location. J Biomech 34:309–317CrossRefGoogle Scholar
  104. 104.
    Nag PK, Vyas H, Nag A, Pal S (2008) Applying stabilometry in characterizing floor sitting modes of women. Int J Ind Ergon 38:984–991CrossRefGoogle Scholar
  105. 105.
    Nag PK, Chintharia S, Saiyed S, Nag A (1986) EMG analysis of sitting work postures in women. Appl Ergon 17:195–197PubMedCrossRefGoogle Scholar
  106. 106.
    Hsiao ET, Robinovitch SN (1998) Common protective movements govern unexpected falls from standing height. J Biomech 31:1–9PubMedCrossRefGoogle Scholar
  107. 107.
    Sabick MB, Hay JG, Goel VK, Banks SA (1999) Active responses decrease impact forces at the hip and shoulder in falls to the side. J Biomech 32:993–998PubMedCrossRefGoogle Scholar
  108. 108.
    DeGoede KM, Ashton-Miller JA (2003) Biomechanical simulations of forward fall arrests: effects of upper extremity arrest strategy, gender and aging-related declines in muscle strength. J Biomech 36:413–420PubMedCrossRefGoogle Scholar
  109. 109.
    Lo J, Ashton-Miller JA (2008) Effect of upper and lower extremity control strategies on predicted injury risk during simulated forward falls: a study in healthy young adults. J Biomech Eng 130:410–415CrossRefGoogle Scholar
  110. 110.
    Nevitt MC, Cummings SR, Hudes ES (1991) Risk factors for injurious falls: a prospective study. J Gerontol 46:M164–M170PubMedCrossRefGoogle Scholar
  111. 111.
    Robinovitch SN, Chiu J, Sandler R, Liu Q (2000) Impact severity in self-initiated sits and falls associates with center-of-gravity excursion during descent. J Biomech 33:863–870PubMedCrossRefGoogle Scholar
  112. 112.
    Weerdesteyn V, Rijken H, Geurts ACH, Smits-Engelsman BCM, Mulder T, Duysens J (2006) A five-week exercise program can reduce falls and improve obstacle avoidance in the elderly. Gerontology 52:131–141PubMedCrossRefGoogle Scholar
  113. 113.
    Weerdesteyn V, Groen BE, van Swigchem R, Duysens J (2008) Martial arts fall techniques reduce hip impact forces in naive subjects after a brief period of training. J Electromyogr Kinesiol 18:235–242PubMedCrossRefGoogle Scholar
  114. 114.
    Groen BE, Smulders E, de Kam D, Duysens J, Weerdesteyn V (2010) Martial arts fall training to prevent hip fractures in the elderly. Osteoporos Int 21:215–221PubMedCrossRefGoogle Scholar
  115. 115.
    Van der Zijden AM, Groen BE, Tanck E, Nienhuis B, Verdonschot N, Weerdesteyn V (2012) Can martial arts techniques reduce fall severity? An in vivo study of femoral loading configurations in sideways falls. J Biomech 45:1650–1655PubMedCrossRefGoogle Scholar
  116. 116.
    Choi WJ, Wakeling JM, Robinovitch SN (2015) Kinematic analysis of video-captured falls experienced by older adults in long-term care. J Biomech 48:911–920PubMedCrossRefGoogle Scholar
  117. 117.
    O'Neill TW, Varlow J, Silman AJ, Reeve J, Reid DM, Todd C, Woolf AD (1994) Age and sex influences on fall characteristics. Ann Rheum Dis 53:773–775PubMedPubMedCentralCrossRefGoogle Scholar
  118. 118.
    Iyo T, Maki Y, Sasaki N, Nakata M (2004) Anisotropic viscoelastic properties of cortical bone. J Biomech 37:1433–1437PubMedCrossRefGoogle Scholar
  119. 119.
    Wu Z, Ovaert TC, Niebur GL (2012) Viscoelastic properties of human cortical bone tissue depend on gender and elastic modulus. J Orthop Res 30:693–699PubMedCrossRefGoogle Scholar
  120. 120.
    Bembey AK, Oyen ML, Bushby AJ, Boyde A (2006) Viscoelastic properties of bone as a function of hydration state determined by nanoindentation. Philos Mag 86:5691–5703CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  1. 1.Department of Mechanical Engineering, Faculty of EngineeringUniversity of ManitobaWinnipegCanada
  2. 2.AI IncorporatedTorontoCanada
  3. 3.Department of Biomedical Engineering, Faculty of EngineeringUniversity of ManitobaWinnipegCanada

Personalised recommendations