Abstract
BackgroundIt is well established that males have lower fracture risk in comparison with females, which suggests a higher bone resistance in men. The aim of our study was to find out if in older patients with hip fragility fractures, gender has also an impact on trabecular bone material behaviour, specifically to determine whether trabecular mechanical properties under compressive loading differ between men and women who suffered a fragility hip fracture.MethodsFemoral epiphyses were consecutively collected during hip replacement surgery due to proximal femur fragility fracture. Trabecular bone cylinders were drilled and submitted to uniaxial compression tests and mechanical properties were assessed.ResultsSeventy-three patients, 55 women (mean age 81 years and standard deviation of 7 years) and 18 men (mean age 81 years and standard deviation of 8 years) were evaluated. The ultimate stress of trabecular bone was significantly higher in men than in women: the median values and the interquartile range (IQR) were respectively 8.04(5.35-10.90) MPa vs. 4.46(3.02-7.73) MPa, (p-value = 0.005). The same difference between male and female was observed in the Young’s modulus: 293.68(166.67-538.18) MPa vs. 174.26(73.07-322.28) MPa, (p-value = 0.028), and also in the energy to failure: 0.25(0.07-0.42) MJ/m3 vs. 0.11(0.05-0.25) MJ/m3, (p-value = 0.058). These differences were also verified after adjusting the analysis for age in a multivariate model analysis.ConclusionsOur observations demonstrated that, even in a population who suffered a fragility hip fracture, men still have higher trabecular bone mechanical properties in comparison with women.
Highlights
It is well established that males have lower fracture risk in comparison with females, which suggests a higher bone resistance in men
Osteoporosis is a systemic skeletal disease characterized by low bone mass, microarchitectural deterioration and strength impairment, which increase the risk of fragility fractures, leading to high morbidity and reducing patient’s quality of life [1,2,3,4,5,6,7]
Bone loss is clinically evaluated by bone mineral density (BMD), but low BMD only explains a minority of the fractures that occur [2,8,9,10], since bone
Summary
It is well established that males have lower fracture risk in comparison with females, which suggests a higher bone resistance in men. The peak number of hip fractures occurs at 75–79 years of age for both sexes [11]. Changes in bone structure and geometry induced by aging contribute to decreased bone strength and increased fragility fracture risk in the elderly population [12,13,16,18,21,22]. Differences between genders get more pronounced with aging [12,13,14,15,16,17,18,19] Another gender difference is related to bone loss at a microstructural level, which occurs mainly by trabecular thinning and reduced bone formation in men and mainly by loss of connectivity between trabeculae in women [1,15,18]
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