The susceptibility of the femoral neck to fracture: an assessment incorporating the effects of age-remodeling and stress reduction

Abstract

Age-related bone remodeling may cause fragility of the femoral neck, thereby increasing fracture risk in elderly populations. We investigated the effects of age-remodeling and stress-reduction on the femoral neck region using the Finite Strip Method (FSM). We verified the possibility that the femoral neck is likely to undergo fracture through two mechanisms: yielding and local buckling. We hypothesized that the femoral necks of young subjects are more prone to fracture by yielding, whereas those of elderly subjects are more susceptible to fracture initiated by local buckling. The slices from the CT-scans of 15 subjects corresponding to the lowest area moment of inertia were segregated into cortex and trabeculae. Geometric and material properties for each strip were obtained from the CT-scans. The FSM, proposed here as an approximation to the better-known Finite Element Method (FEM), was implemented on a model comprising both cortex and trabeculae. Finite strip (FS) analyses were performed on models that incorporated the effects of age-related bone remodeling, as well as a reduction in physiological stress on the bone (as a result of weight loss). Comparisons were made with similar FS analyses performed on only the cortical shell, in order to ascertain the contributions of the trabeculae to femoral neck strength. We observed that the femoral necks of simulated young subjects manifested a marked predisposition to undergo yielding, whereas the femoral neck models of simulated elderly subjects were more prone to buckling before yielding. The trabecular degradation and cortical thinning involved in aging render the femoral neck more susceptible to failure by buckling.