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Three-Dimensional Microstructural Basis for Differential Occurrence of Subcapital versus Basicervical Hip Fractures in Men

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Abstract

We analyzed the bone microarchitecture of the subcapital and basicervical subregions of the femoral neck in men, to determine whether microarchitectural differences of cortical or trabecular bone can explain differential frequency of subcapital vs. basicervical fractures, especially in aged persons. The study sample encompassed twenty male proximal femora obtained during autopsy. They were divided in two age groups: young (< 40 years, n = 10) and aged (> 60 years, n = 10). Micro-computed tomography was used to evaluate cortical and trabecular microarchitecture of the subcapital and basicervical regions of the superolateral femoral neck–typical fracture initiation site. Basicervical region showed significantly thicker and less porous cortex than subcapital region (p = 0.02, p < 0.001, respectively), along with increased distance between cortical pores (p = 0.004) and smaller pore diameters (p = 0.069). Higher trabecular number (Tb.N: p = 0.042), lower trabecular thickness (Tb.Th: p < 0.001), and lower trabecular separation (p = 0.003) were also hallmarks of the basicervical compared to subcapital region, although BV/TV was similar in both regions (p = 0.133). Age-related deterioration was mostly visible in trabecular bone (for BV/TV, Tb.Th, Tb.N and fractal dimension: p = 0.026, p = 0.049, p = 0.059, p = 0.009, respectively). Moreover, there were tendencies to age-specific patterns of trabecular separation (more pronounced inter-site differences in aged) and cortical thickness (more pronounced inter-site differences in young). Trabecular microarchitecture corresponded to cortical characteristics of each region. Our study revealed the microarchitectural basis for higher incidence of subcapital than basicervical fractures of the femoral neck. This is essential for better understanding of the fracture risk, as well as for future strategies to prevent hip fractures and their complications.

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Data Availability

The data that support the findings of this study are available from the corresponding author [P.M] upon reasonable request.

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Funding

The authors thank the Science Fund of the Republic of Serbia for support.

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Authors and Affiliations

  1. Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia

    Aleksandar Cirovic, Ana Cirovic, Danijela Djonic, Marija Djuric & Petar Milovanovic

  2. Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia

    Vladimir Zivkovic & Slobodan Nikolic

Authors
  1. Aleksandar Cirovic
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  2. Ana Cirovic
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  3. Danijela Djonic
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  4. Vladimir Zivkovic
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  5. Slobodan Nikolic
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  6. Marija Djuric
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  7. Petar Milovanovic
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Correspondence to Petar Milovanovic.

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Conflict of interest

Aleksandar Cirovic, Ana Cirovic, Danijela Djonic, Vladimir Zivkovic, Slobodan Nikolic, Marija Djuric, and Petar Milovanovic declare that they have no conflict of interest.

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All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The collection of the cadaveric bone specimens was approved by the Ethics Committee of the Faculty of Medicine, University of Belgrade.

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Cirovic, A., Cirovic, A., Djonic, D. et al. Three-Dimensional Microstructural Basis for Differential Occurrence of Subcapital versus Basicervical Hip Fractures in Men. Calcif Tissue Int 107, 240–248 (2020). https://doi.org/10.1007/s00223-020-00717-z

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