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Focal Osteoporosis and Its Role in Subcapital Hip Fracture

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Osteoporotic Fracture and Systemic Skeletal Disorders

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Abstract

Hip fracture leads to hospitalisation, morbidity, and mortality. While generalised osteoporosis is a well-known risk factor for hip fracture, focal osteoporosis also plays an important role in cervical hip fracture, particularly the subcapital type.

Many studies have characterised the structural heterogeneity of the ‘normal’ femoral head, using histomorphometric and computed tomography (CT) techniques. Samples from patients with osteoporosis have been shown to have fewer, thinner, less connected trabeculae in all sites studied when compared with controls. Laboratory simulations have concluded that just a small proportion of bone needs to fail for a hip fracture to occur on impact.

Cortical bone mapping (CBM) techniques based on clinical CT scans have found important focal differences between hip fracture patients and controls. Studies using CBM have revealed patches of focal osteoporosis, within the bone of the proximal femur, that are specific for the type of hip fracture sustained. These patches are also distinct from patterns seen in normal ageing.

A histomorphometric study of bone cores taken from cervical hip fracture samples has provided evidence to support the CBM findings of focal osteoporosis.

Focal osteoporosis is worth targeting in order to understand the tissue pathology and reduce hip fracture susceptibility.

The present invited review was completed and submitted to the publisher on 14-Oct-20. 

This chapter is modified from the Masters’ thesis of Dr. Linda Skingle (Darwin College, Cambridge) entitled, ‘A Study of the Microstructure of the Femoral Head’, Cambridge University 2019 and the journal article of Dr. Graham Treece and Dr. Andrew Gee, ‘Cortical Bone Mapping: Measurement and Statistical Analysis of Localised Skeletal Changes’ Curr Osteoporos Rep. 2018; 16(5): 617–625. Published online 2018 Aug 28. doi: https://doi.org/10.1007/s11914-018-0475-3

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Author information

Authors and Affiliations

  1. Department of Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    Kenneth E. S. Poole & Linda Skingle

  2. Department of Engineering, University of Cambridge, Cambridge, UK

    Andrew H. Gee & Graham M. Treece

Authors
  1. Kenneth E. S. Poole
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  2. Linda Skingle
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  3. Andrew H. Gee
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  4. Graham M. Treece
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Corresponding author

Correspondence to Kenneth E. S. Poole .

Editor information

Editors and Affiliations

  1. Niigata Bone Science Institute, Niigata Rehabilitation Hospital, Niigata, Japan

    Hideaki E. Takahashi

  2. Department of Anatomy, Cell Biology and Physiology, Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA

    David B. Burr

  3. Niigata Bone Science Institute, Niigata Rehabilitation Hospital, Niigata, Japan

    Noriaki Yamamoto

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Poole, K.E.S., Skingle, L., Gee, A.H., Treece, G.M. (2022). Focal Osteoporosis and Its Role in Subcapital Hip Fracture. In: Takahashi, H.E., Burr, D.B., Yamamoto, N. (eds) Osteoporotic Fracture and Systemic Skeletal Disorders. Springer, Singapore. https://doi.org/10.1007/978-981-16-5613-2_14

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  • DOI: https://doi.org/10.1007/978-981-16-5613-2_14

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