Abstract
Background: The femoral neck is a common osteoporotic fracture site. In this study we investigate changes in mean periosteal thickness with age, sex, side and circumference along the femoral neck. We hypothesised that: periosteal thickness declines with age, that the periosteum is thicker in males, is thickest inferiorly around the neck, and becomes thicker distally along the neck. Methods and findings: Sixteen femoral necks from 9 cadavers (mean age 82.78, 5 female, 4 male) were sectioned, decalcified and stained. Periosteal thickness in 4 quadrants around the circumference, and along its length, was measured. The difference in mean periosteal coverage between sexes was found to be insignificant (p=0.2857), and did not appear to decline with age (p=0.7760). No significant changes in periosteal thickness were seen along the length of the neck (p=0.9594). There was, however, a significant difference in coverage around the circumference of the femoral neck (p<0.0001). Conclusions: The differences in periosteal coverage around the circumference of the femoral neck reported here are open to several theories. There may be potential for pharmacological intervention, gene-related therapy or periosteal transplant to target specifically vulnerable sites.
Highlights
The periosteum plays a major role in bone growth and repair
Shea et al [9] reported calcification and capsular mineralisation between the femoral head and neck in the elderly, which may account for at least some of the increased femoral neck width seen with age, making it difficult to determine how much of the increase is due to mineralisation and how much is due to periosteal bone formation
The aim of this study is to elucidate the coverage of periosteum around and along the femoral neck, by investigating changes in mean periosteal thickness with age, sex, side and circumference along the femoral neck in cadaveric specimens; and whether this can be associated with relative osteoporotic fracture risk
Summary
The periosteum plays a major role in bone growth and repair. Bone ossifies by two processes of ossification: membranous and endochondral. Periosteal circumference has been reported to increase with age, accounting for the growing thickness of the femoral neck in some subjects [8]. Shea et al [9] reported calcification and capsular mineralisation between the femoral head and neck in the elderly, which may account for at least some of the increased femoral neck width seen with age, making it difficult to determine how much of the increase is due to mineralisation and how much is due to periosteal bone formation. In this study we investigate changes in mean periosteal thickness with age, sex, side and circumference along the femoral neck. Conclusions: The differences in periosteal coverage around the circumference of the femoral neck reported here are open to several theories. There may be potential for pharmacological intervention, gene-related therapy or periosteal transplant to target vulnerable sites
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