Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia.
Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia.
Calcif Tissue Int. 2020 Sep;107(3):240-248. doi: 10.1007/s00223-020-00717-z. Epub 2020 Jun 29.
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.
我们分析了男性股骨颈头下区和基底部区域的骨微结构，以确定皮质骨或松质骨的微结构差异是否可以解释头下区与基底部骨折的不同发生率，尤其是在老年人中。研究样本包括 20 个尸检获得的男性近端股骨。它们被分为两个年龄组：年轻组（<40 岁，n=10）和老年组（>60 岁，n=10）。微计算机断层扫描用于评估股骨颈超外侧-典型骨折起始部位的头下区和基底部区域的皮质骨和松质骨微结构。基底部区域的皮质骨比头下区更厚且多孔性更小（p=0.02，p<0.001），皮质骨孔之间的距离也更大（p=0.004），孔径更小（p=0.069）。基底部区域的松质骨骨量更高（Tb.N：p=0.042），松质骨厚度更小（Tb.Th：p<0.001），松质骨分离更大（p=0.003），尽管两个区域的 BV/TV 相似（p=0.133）。与头下区相比，年龄相关性恶化在松质骨中更为明显（对于 BV/TV、Tb.Th、Tb.N 和分形维数：p=0.026、p=0.049、p=0.059、p=0.009）。此外，松质骨分离存在年龄特异性模式的趋势（老年组的站点间差异更明显），皮质骨厚度也存在趋势（年轻组的站点间差异更明显）。松质骨微结构与每个区域的皮质特征相对应。我们的研究揭示了股骨颈头下区骨折发生率高于基底部骨折的微观结构基础。这对于更好地理解骨折风险以及未来预防髋部骨折及其并发症的策略至关重要。
