Advertisement

Etiology and Biomechanics of Hip and Vertebral Fractures

  • Mary L. Bouxsein
  • Karl J. Jepsen

Abstract

Fractures are one of the most dramatic and devastating sequelae of the aging of the human skeleton. In the United States alone, more than 1.5 million age-related fractures occur annually, inducting 300,000 hip and 500,000 vertebral fractures. Associated medical expenditures amount to nearly $14 billion annually. Moreover, on the basis of current demographic trends, which predict a dramatic increase in the number of individuals older than 70 years of age, the number of fractures is projected to double or triple in the next 50 years [1]. Clearly, interventions for reducing the incidence of fracture are needed. To be most effective, these interventions must be based on a sound understanding of the cause of fractures. In the past, the predominant view was that age-related fractures were strictly a consequence of bone loss. This view was based on studies showing a dramatic increase in fracture incidence with age and a greater fracture rate in women than in men (see Chapter 1). However, recent evidence indicates that factors related not only to skeletal fragility but also to skeletal loading influence the risk of fracture.

Keywords

Bone Mineral Density Vertebral Fracture Trabecular Bone Failure Load Fracture Intervention Trial 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Cummings SR, Melton LJ: Epidemiology and outcomes of osteoporotic fractures. Lancet 2002, 359:1761–1767.PubMedCrossRefGoogle Scholar
  2. 2.
    Carter DR, Hayes WC:The compressive behavior of bone as a two-phase porous structure. J Bone Joint Surg Am 1977, 59:954–962.PubMedGoogle Scholar
  3. 3.
    Seeman E: Pathogenesis of bone fragility in men and women. Lancet 2002, 359:1841–1850.PubMedCrossRefGoogle Scholar
  4. 4.
    Gliier CC, Cummings SR, Pressman A, et al.: Prediction of hip fractures from pelvic radiographs: the Study of Osteoporotic Fractures. J Bone Miner Res 1994, 9:671–677.CrossRefGoogle Scholar
  5. 5.
    Seeman E, Duan Y, Fong C, Edmonds J: Fracture site-specific deficits in bone size and volumetric density in men with spine or hip fractures. J Bone Miner Res 2001, 16:120–127.PubMedCrossRefGoogle Scholar
  6. 6.
    Burstein A, Reilly D, Martens M: Aging of bone tissue: mechanical properties. J Bone Joint Surg Am 1976, 58:82–86.PubMedGoogle Scholar
  7. 7.
    Mosekilde L, Mosekilde L, Danielson CC: Biomechanical competence of vertebral trabecular bone in relation to ash density and age in normal individuals. Bone 1987, 8:79–85.PubMedCrossRefGoogle Scholar
  8. 8.
    Einhorn TA: Bone strength: the bottom line. Calcif Tissue Int 1992, 51:333–339.PubMedCrossRefGoogle Scholar
  9. 9.
    Fazzalari NL, Forwood MR, Manthey BA, et al.:Three-dimensional confocal images of microdamage in cancellous bone. Bone 1998, 23:373–378.PubMedCrossRefGoogle Scholar
  10. 10.
    Schaffler M, Choi K, Milgrom C: Aging and matrix microdamage accumulation in human compact bone. Bone 1995, 17:521–525.PubMedCrossRefGoogle Scholar
  11. 11.
    Mori S, Harruff R, Ambrosius W, Burr DB: Trabecular bone volume and microdamage accumulation in the femoral heads of women with and without femoral neck fractures. Bone 1997, 21:521–525.PubMedCrossRefGoogle Scholar
  12. 12.
    Burr D, Forwood M, Fyhrie D, et al.: Bone microdamage and skeletal fragility in osteoporotic and stress fractures. J Bone Miner Res 1997, 12:6–15.PubMedCrossRefGoogle Scholar
  13. 13.
    Hayes W, Piazza S, Zysset P: Biomechanics of fracture risk prediction of the hip and spine by quantitative computed tomography. Radiol Clin North Am 1991, 29:1–18.PubMedGoogle Scholar
  14. 14.
    Hayes WC: Biomechanics of cortical and trabecular bone: implications for assessment of fracture risk. In Basic Orthopaedic Biomechanics. Edited by Mow VC, Hayes WC. New York: Raven Press; 1991:93–142.Google Scholar
  15. 15.
    Greenspan SL, Myers ER, Maitland LA, et al.: Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA 1994, 217:128–133.CrossRefGoogle Scholar
  16. 16.
    Cummings SR, Black DM, Nevitt MC, et al.: Bone density at various sites for prediction of hip fractures. Lancet 1993, 341:72–75.PubMedCrossRefGoogle Scholar
  17. 17.
    Hans D, Dargent-Molina P, Schott A, et al.: Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 1996, 348:511–514.PubMedCrossRefGoogle Scholar
  18. 18.
    Marshall D, Johnell O, Wedel H: Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996, 312:1254–1259.PubMedCrossRefGoogle Scholar
  19. 19.
    Bouxsein ML, Courtney AC, Hayes WC: Ultrasound and densitometry of the calcaneus correlate with the failure loads of cadaveric femurs. Calcif Tissue Int 1995, 56:99–103.PubMedCrossRefGoogle Scholar
  20. 20.
    Courtney A, Wachtel EF, Myers ER, et al.: Effects of loading rate on the strength of the proximal femur. Calcif Tissue Int 1994, 55:53–58.PubMedCrossRefGoogle Scholar
  21. 21.
    Courtney A, Wachtel EF, Myers ER, et al.: Age-related reductions in the strength of the femur tested in a fall-loading configuration. J Bone Joint Surg Am 1995,77:387–395.PubMedGoogle Scholar
  22. 22.
    Black DM, Cummings SR, Karpf DB, et al.: Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996, 348:1535–1541.PubMedCrossRefGoogle Scholar
  23. 23.
    Myers E, Wilson S, Greenspan S: Vertebral fractures in the elderly occur with falling and bending. J Bone Miner Res 1996, 11:S355.Google Scholar
  24. 24.
    Wilson SE, Myers ER, Hayes WC: A computer program to analyze the loading on a vertebra associated with age-related vertebral fractures. Paper represented at MIT Health Sciences and Technology Forum, Cambridge, MA, 1994.Google Scholar
  25. 25.
    Moro M, Hecker AT, Bouxsein ML, et al.: Failure load of thoracic vertebrae correlates with lumbar bone mineral density measured by DXA. Calcif Tissue Int 1995, 56:206–209.PubMedCrossRefGoogle Scholar
  26. 26.
    Myers E, Wilson S: Biomechanics of osteoporosis and vertebral fractures. Spine 1997, 22:25S–31S.CrossRefGoogle Scholar
  27. 27.
    Nelson ME, Fiatarone MA, Morganti CM, et al.: Effects of high intensity strength training on multiple risk factors for osteoporotic fractures. JAMA 1994, 272:1909–1914.PubMedCrossRefGoogle Scholar
  28. 28.
    Robinovitch SN, Hayes WC, McMahon TA: Energy-shunting hip padding system attenuates femoral impact force in a simulated fall. J Biomech Eng 1995, 117:409–413.PubMedCrossRefGoogle Scholar
  29. 29.
    Lauritzen JB, Peterson MM, Lund B: Effect of external hip protectors on hip fractures. Lancet 1993, 341:11–13.PubMedCrossRefGoogle Scholar
  30. 30.
    Kannus P, Parkkari J, Niemi S, et al.: Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med 2000, 343:1506–1513.PubMedCrossRefGoogle Scholar
  31. 31.
    Ekman A, Mallmin H, Micaëlsson K, Ljunghall S: External hip protectors to prevent osteoporotic hip fractures. Lancet 1997, 350:563–564.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Mary L. Bouxsein
  • Karl J. Jepsen

There are no affiliations available

Personalised recommendations