Three-dimensional anatomy of the cancellous structures within the proximal femur from computed tomography data

Functional morphology of trabecular system in human proximal femur: a perspective from P45 sectional plastination and 3D reconstruction finite element analysis

BACKGROUND

The trabecular architecture of proximal femur plays a crucial role in hip stability and load distribution and is often ignored in hip fracture fixation due to limited anatomical knowledge. This study analyses trabecular morphology and stress distribution, aiming to provide an anatomical foundation for optimising implant designs.

MATERIALS AND METHODS

Twenty-one formalin-fixed human pelvises (twelve male, nine female) were prepared using P45 sectional plastination. They were sliced into 3 mm sections in the coronal, sagittal, and horizontal planes and then photographed. A 3D femur model was created from computed tomographic scans and analysed for finite element analysis (FEA) using Mimics, 3-matics, and Abaqus software to simulate static and dynamic loads, visualising stress paths for compressive and tensile regions and identifying fracture-vulnerable zones.

RESULTS

Two main trabecular systems were identified: the medial and lateral systems. The medial system includes a primary vertical trabecular group extending from the femoral shaft's medial calcar to the head and two primary horizontal groups arching from the lateral shaft, greater trochanter, and femoral neck's anterolateral and posterolateral walls toward the medial side, intersecting with the primary vertical group in the head. Secondary vertical group intersects with secondary horizontal group at the neck-trochanteric junction to form the lateral system. FEA showed peak compressive stress along the vertical groups, calcar, and medial cortex, and tensile stress along the horizontal groups, greater trochanter, and lateral cortex, creating balanced support that stabilises the femoral neck and shaft.

CONCLUSION

The strength of proximal femur depends on dense cortical bone, calcar femorale, lateral and medial trabecular systems, and greater trochanter. While anterolateral and posterolateral areas of femoral neck and intertrochanteric regions are potential weak zones. Trabecular pattern follows stress paths, optimising load distribution. These insights aid in designing robotic and bionic implants that mimic natural stress patterns, reducing complications.

The qualitative analysis of trabecular architecture of the proximal femur based on the P45 sectional plastination technique

The primary weight-bearing structure of the proximal femur, trabecular bone, has a complex three-dimensional architecture that was previously difficult to comprehensively display. This study examined the spatial architecture of trabecular struts in the coronal, sagittal, and horizontal sections of the proximal femur using 21 cases prepared with P45 sectional plasticization. The primary compressive strut (PCS) exhibited a "mushroom-like" shape with upper and lower parts. The lower part extended from the medial inferior cortical bone of the femoral neck to the central region of the femoral head, while the upper part radiated from the epiphyseal line to the subchondral cortical bone of the femoral head. The secondary compressive strut (SCS), originated below the distal end of the PCS, ran diagonally upward, and intersected with the secondary tensile strut (STS) within the greater trochanter. The primary tensile strut (PTS) comprised anterior (aPTS) and posterior (pPTS) components originating from the anterior- and posterior-superior cortical bone of the femoral neck. These converged, entered the femoral head, intersected with the PCS beneath the epiphyseal line, forming a dense trabecular center, and terminated at the subchondral cortical bone below the fovea of the femoral head. The secondary tensile strut (STS) originated from the cortical bone around the lower edge of the greater trochanter, converging upwards and medially to terminate at the superior cortical bone of the femoral neck. The trabecular system of the proximal femur consists of two subsystems: one between the femoral head and neck, and another between the femoral neck and shaft. The head-neck system comprises intersecting PCS, aPTS, and pPTS, facilitating stress transmission. The neck-shaft system features intersecting STS and SCS, enabling stress transmission between these regions. These independent systems are separated by Ward's triangle. The findings of this study offer anatomical guidance for the improvement of internal fixation methods, orthopedic implants, and the design of surgical robots.

Quantitative Analysis of Primary Compressive Trabeculae Distribution in the Proximal Femur of the Elderly

OBJECTIVE

As osteoporosis progresses, the primary compressive trabeculae (PCT) in the proximal femur remains preserved and is deemed the principal load-bearing structure that links the femoral head with the femoral neck. This study aims to elucidate the distribution patterns of PCT within the proximal femur in the elderly population, and to assess its implications for the development and optimization of internal fixation devices used in hip fracture surgeries.

METHODS

This is a retrospective cohort study conducted from March 2022 to April 2023. A total of 125 patients who underwent bilateral hip joint CT scans in our hospital were enrolled. CT data of the unaffected side of the hip were analyzed. Key parameters regarding the PCT distribution in the proximal femur were measured, including the femoral head's radius (R), the neck-shaft angle (NSA), the angle between the PCT-axis and the head-neck axis (α), the distance from the femoral head center to the PCT-axis (δ), and the lengths of the PCT's bottom and top boundaries (L-bottom and L-top respectively). The impact of gender differences on PCT distribution patterns was also investigated. Student's t-test or Mann-Whitney U test were used to compare continuous variables between genders. The relationship between various variables was investigated through Pearson's correlation analysis.

RESULTS

PCT was the most prominent bone structure within the femoral head. The average NSA, α, and δ were 126.85 ± 5.85°, 37.33 ± 4.23°, and 0.39 ± 1.22 mm, respectively, showing no significant gender differences (p > 0.05). Pearson's correlation analysis revealed strong correlations between α and NSA (r = -0.689, p < 0.001), and R and L-top (r = 0.623, p < 0.001), with mild correlations observed between δ and NSA (r = -0.487, p < 0.001), and R and L-bottom (r = 0.427, p < 0.001). Importantly, our study establishes a method to accurately localize PCT distribution in true anteroposterior (AP) radiographs of the hip joint, facilitating precise screw placement in proximal femur fixation procedures.

CONCLUSION

Our study provided unprecedented insights into the distribution patterns of PCT in the proximal femur of the elderly population. The distribution of PCT in the proximal femur is predominantly influenced by anatomical and geometric factors, such as NSA and femoral head size, rather than demographic factors like gender. These insights have crucial implications for the design of internal fixation devices and surgical planning, offering objective guidance for the placement of screws in hip fracture treatments.

Is bone mineral density lower in the necrotic lesion in pre-collapse osteonecrosis of the femoral head?

The purpose of this study was to clarify whether bone mineral density (BMD) of the necrotic lesion in precollapse osteonecrosis of the femoral head (ONFH) is reduced according to Hounsfield unit (HU) values on computed tomography (CT). The superior one-third of the femoral head in the coronal section was set as the region of interest (ROI) for the measurement of HU values. First, HU values of 101 control participants were assessed to identify relevant confounding factors. Next, the relationship between HU values and BMD on dual-energy X-ray absorptiometry (DXA) was verified. Then the mean HU value of the ROI in patients with pre-collapse ONFH was compared with that in propensity score-matched control participants. Finally, the HU values of the lateral boundary in the patients with and without subsequent collapse were compared. Multivariable analysis showed that both age and BMI were significantly correlated with the HU value, which showed a strong correlation with the BMD of the femoral neck on DXA (r = 0.92). In 25 ONFH patients and 25 propensity-matched control participants, no significant difference was found in the HU value of the ROI (p = .54). The mean HU value of the lateral boundary in patients with subsequent collapse was found to be significantly higher than that in patients without subsequent collapse (p < .01). The assessment of HU values on CT was useful for the evaluation of BMD of the femoral head. The current assessment did not demonstrate reduced bone mineral density of the necrotic lesion in pre-collapse ONFH.

Cancellous bone and theropod dinosaur locomotion. Part I-an examination of cancellous bone architecture in the hindlimb bones of theropods

This paper is the first of a three-part series that investigates the architecture of cancellous ('spongy') bone in the main hindlimb bones of theropod dinosaurs, and uses cancellous bone architectural patterns to infer locomotor biomechanics in extinct non-avian species. Cancellous bone is widely known to be highly sensitive to its mechanical environment, and has previously been used to infer locomotor biomechanics in extinct tetrapod vertebrates, especially primates. Despite great promise, cancellous bone architecture has remained little utilized for investigating locomotion in many other extinct vertebrate groups, such as dinosaurs. Documentation and quantification of architectural patterns across a whole bone, and across multiple bones, can provide much information on cancellous bone architectural patterns and variation across species. Additionally, this also lends itself to analysis of the musculoskeletal biomechanical factors involved in a direct, mechanistic fashion. On this premise, computed tomographic and image analysis techniques were used to describe and analyse the three-dimensional architecture of cancellous bone in the main hindlimb bones of theropod dinosaurs for the first time. A comprehensive survey across many extant and extinct species is produced, identifying several patterns of similarity and contrast between groups. For instance, more stemward non-avian theropods (e.g. ceratosaurs and tyrannosaurids) exhibit cancellous bone architectures more comparable to that present in humans, whereas species more closely related to birds (e.g. paravians) exhibit architectural patterns bearing greater similarity to those of extant birds. Many of the observed patterns may be linked to particular aspects of locomotor biomechanics, such as the degree of hip or knee flexion during stance and gait. A further important observation is the abundance of markedly oblique trabeculae in the diaphyses of the femur and tibia of birds, which in large species produces spiralling patterns along the endosteal surface. Not only do these observations provide new insight into theropod anatomy and behaviour, they also provide the foundation for mechanistic testing of locomotor hypotheses via musculoskeletal biomechanical modelling.

Structural patterns of the proximal femur in relation to age and hip fracture risk in women

Fractures of the proximal femur are the most devastating outcome of osteoporosis. It is generally understood that age-related changes in hip structure confer increased risk, but there have been few explicit comparisons of such changes in healthy subjects to those with hip fracture. In this study, we used quantitative computed tomography and tensor-based morphometry (TBM) to identify three-dimensional internal structural patterns of the proximal femur associated with age and with incident hip fracture. A population-based cohort of 349 women representing a broad age range (21-97years) was included in this study, along with a cohort of 222 older women (mean age 79±7years) with (n=74) and without (n=148) incident hip fracture. Images were spatially normalized to a standardized space, and age- and fracture-specific morphometric features were identified based on statistical maps of shape features described as local changes of bone volume. Morphometric features were visualized as maps of local contractions and expansions, and significance was displayed as Student's t-test statistical maps. Significant age-related changes included local expansions of regions low in volumetric bone mineral density (vBMD) and local contractions of regions high in vBMD. Some significant fracture-related features resembled an accentuated aging process, including local expansion of the superior aspect of the trabecular bone compartment in the femoral neck, with contraction of the adjoining cortical bone. However, other features were observed only in the comparison of hip fracture subjects with age-matched controls including focal contractions of the cortical bone at the superior aspect of the femoral neck, the lateral cortical bone just inferior to the greater trochanter, and the anterior intertrochanteric region. Results of this study support the idea that the spatial distribution of morphometric features is relevant to age-related changes in bone and independent to fracture risk. In women, the identification by TBM of fracture-specific morphometric alterations of the proximal femur, in conjunction with vBMD and clinical risk factors, may improve hip fracture prediction.

The application of digital volume correlation (DVC) to study the microstructural behaviour of trabecular bone during compression

Digital Volume Correlation (DVC) has been emerged recently as an innovative approach to full volume (i.e. internal) displacement and strain field measurement in materials and structures, particularly in conjunction with high resolution X-ray computed tomography (CT). As a relatively novel technique certain aspects of precision, accuracy and the breadth of application are yet to be fully established. This study has applied DVC to volume images of porcine trabecular bone assessing the effect of noise and sub-volume size on strain measurement. Strain resolutions ranging between 70 and 800με were obtained for the optimum sub-volume size of 64 voxels with a 50% overlap for metrological studies conducted. These values allowed the mechanical behaviour of porcine trabecular bone during compression to be investigated. During compression a crushed layer formed adjacent to the boundary plate which increased in thickness as the specimen was further deformed. The structure of the crushed layer was altered to such an extent that it confounded the correlation method. While investigating this factor, it was found that for reliable strain calculations a correlation coefficient of 0.90 or above was required between the sub-volumes in the reference and the deformed volumes. Good agreements between the results and published bone strain failures were obtained. Using the full field strain measurements, Poisson's ratio was identified for each compression step using a dedicated inverse method called the virtual fields method (VFM). It was found that for a given region outside of the crushed zone the Poisson ratio decreased from 0.32 to 0.21 between the first and the final compression steps, which was hypothesised to be due to the bone geometry and its resulting deformation behaviour. This study demonstrates that volumetric strain measurement can be obtained successfully using DVC, making it a useful tool for quantitatively investigating the micro-mechanical behaviour of macroscale bone specimens.

Subchondral bone density distribution in the human femoral head

OBJECTIVE

This study aims to quantitatively characterize the distribution of subchondral bone density across the human femoral head using a computed tomography derived measurement of bone density and a common reference coordinate system.

MATERIALS AND METHODS

Femoral head surfaces were created bilaterally for 30 patients (14 males, 16 females, mean age 67.2 years) through semi-automatic segmentation of reconstructed CT data and used to map bone density, by shrinking them into the subchondral bone and averaging the greyscale values (linearly related to bone density) within 5 mm of the articular surface. Density maps were then oriented with the center of the head at the origin, the femoral mechanical axis (FMA) aligned with the vertical, and the posterior condylar axis (PCA) aligned with the horizontal. Twelve regions were created by dividing the density maps into three concentric rings at increments of 30° from the horizontal, then splitting into four quadrants along the anterior-posterior and medial-lateral axes. Mean values for each region were compared using repeated measures ANOVA and a Bonferroni post hoc test, and side-to-side correlations were analyzed using a Pearson's correlation.

RESULTS

The regions representing the medial side of the femoral head's superior portion were found to have significantly higher densities compared to other regions (p < 0.05). Significant side-to-side correlations were found for all regions (r(2) = 0.81 to r(2) = 0.16), with strong correlations for the highest density regions. Side-to-side differences in measured bone density were seen for two regions in the anterio-lateral portion of the femoral head (p < 0.05).

CONCLUSIONS

The high correlation found between the left and right sides indicates that this tool may be useful for understanding 'normal' density patterns in hips affected by unilateral pathologies such as avascular necrosis, fracture, developmental dysplasia of the hip, Perthes disease, and slipped capital femoral head epiphysis.

Cam morphology in the human hip

A growing interest exists in the diagnosis and treatment of femoroacetabular impingement. Although cam morphology of the proximal femur may conceptually appear to be a relatively simple topographical aberrancy, it is actually positioned amid a complex developmental, kinematic, and biomechanical region of the human body. The authors introduce a new classification scheme and review the historical and anthropological considerations, biomechanics, and genetic factors involved in cam morphology.

Brief communication: radiographic study of metatarsal one basal epiphyseal fusion: a note of caution on age determination

This study examines radiographs of first metatarsals of 131 individuals from age 17-88 years to determine whether internal basal epiphyseal lines may be visible past the age of metatarsal fusion, which usually occurs between 14 and 16 years of age (Scheuer and Black: The juvenile skeleton. San Diego: Elsevier Academic Press,2004). In 29% (38 out of 131) of the radiographed first metatarsals (MT1s) the basal epiphyseal scar is visible, including in one individual who was 80 years old. Statistically, there was no relationship between the loss of the epiphyseal scar and age. Thus, the presence of the epiphyseal scar does not necessarily indicate subadult age. These data suggest that OH 8's radiographically visible basal epiphyseal line has no bearing on whether it is a subadult or not.

Morphological analysis of the proximal femur using quantitative computed tomography

The anatomy of the proximal femur was studied in 35 specimens using quantitative computed tomography (QCT) and compared with anatomical sections studied by plane radiography and gross dissection. We found the primary supporting structure of the femoral head to be the primary compressive strut, which is a dense column of trabecular bone projecting from the pressure buttress of the medial femoral neck to the epiphyseal scar. Trabecular bone mushroomed from the epiphyseal scar and terminated at right angles to the cortex of the femoral head. We believe the primary compressive strut is the predominant load-bearing structure connecting the femoral head to the femoral neck, as many specimens lacked continuity of the head cortex to the femoral neck. Based on the CT number, the primary compressive strut had similar bone density to cortical structures such as the lesser trochanter, calcar femorale and posterior lateral femoral cortex. Ward's triangle lacked structural integrity in many cases, and we doubt the significance of tensile trabculae for sharing load. Surgical techniques such as femoral fracture fixation, resurfacing hip arthroplasty and allograft transplantation may benefit from this knowledge.

Mathematical analysis of trabecular 'trajectories' in apparent trajectorial structures: the unfortunate historical emphasis on the human proximal femur

Wolff's "law" of the functional adaptation of bone is rooted in the trajectory hypothesis of cancellous bone architecture. Wolff often used the human proximal femur as an example of a trajectorial structure (i.e. arched trabecular patterns appear to be aligned along tension/compression stress trajectories). We examined two tenets of the trajectory hypothesis; namely, that the trabecular tracts from the tension- and compression-loaded sides of a bending environment will: (1) follow 'lines' (trajectories) of tension/compression stress that resemble an arch with its apex on a neutral axis, and (2) form orthogonal (90 degrees ) intersections. These predictions were analysed in proximal femora of chimpanzees and modern humans, and in calcanei of sheep and deer. Compared to complex loading of the human femoral neck, the chimpanzee femoral neck reputedly receives relatively simpler loading (i.e. temporally/spatially more consistent bending), and the artiodactyl calcaneus is even more simply loaded in bending. In order to directly consider Wolff's observations, measurements were also made on two-dimensional, cantilevered beams and curved beams, each with intersecting compression/tension stress trajectories. Results in the calcanei showed: (1) the same nonlinear equation best described the dorsal ("compression") and plantar ("tension") trabecular tracts, (2) these tracts could be exactly superimposed on the corresponding compression/tension stress trajectories of the cantilevered beams, and (3) trabecular tracts typically formed orthogonal intersections. In contrast, trabecular tracts in human and chimpanzee femoral necks were non-orthogonal (mean approximately 70 degrees ), with shapes differing from trabecular tracts in calcanei and stress trajectories in the beams. Although often being described by the same equations, the trajectories in the curved beams had lower r(2) values than calcaneal tracts. These results suggest that the trabecular patterns in the calcanei and stress trajectories in short beams are consistent with basic tenets of the trajectory hypothesis while those in human and chimpanzee femoral necks are not. Compared to calcanei, the more complexly loaded human and chimpanzee femoral necks probably receive more prevalent/predominant shear, which is best accommodated by non-orthogonal, asymmetric trabecular tracts. The asymmetrical trabecular patterns in the proximal femora may also reflect the different developmental 'fields' (trochanteric vs. neck/head) that formed these regions, of which there is no parallel in the calcanei.

Histomorphometric analysis of the proximal portion of the femur in dogs with moderate osteoarthritis

OBJECTIVE

To describe the histomorphometric properties of epiphyseal and metaphyseal trabecular bone of the proximal portion of the femur of dogs with moderate osteoarthritis.

SAMPLE POPULATION

Proximal portions of a femour from 24 dogs.

PROCEDURE

The proximal portion of a femur was obtained from each dog. Eleven and thirteen specimens were sectioned in the transverse and coronal planes, respectively. Three evenly spaced sections from each specimen were chosen, surface stained, and digitized, and the stained areas were preferentially selected. Custom software was used for histomorphometric analysis of each section. A mixed-model analysis was used to evaluate the effect of slice location and region on 6 parameters, and a Fisher protected t test was used when differences were detected.

RESULTS

There was a significant difference between the femoral head and femoral neck for all parameters tested. In coronal sections, the femoral neck was significantly more anisotropic than the femoral head. In transverse sections, the craniolateral region of the femoral neck was significantly more anisotropic than the caudomedial and craniomedial regions.

CONCLUSIONS AND CLINICAL RELEVANCE

There is a predictable cancellous microarchitecture in the proximal portion of femurs from dogs with moderate osteoarthritis. Trabeculae are more numerous, thicker, and closer together but more randomly arranged in the femoral head than in the femoral neck. Dogs with moderate osteoarthritis had an increase in trabecular anisotropy in the craniolateral region of the femoral neck. However, there was no corresponding increase in trabecular alignment of the proximomedial region of the femoral head. Results support an association between trabecular alignment and the progression of osteoarthritis.

MicroCT evaluation of normal and osteoarthritic bone structure in human knee specimens

Although trabecular bone structure has been evaluated, variation with knee compartment and depth from joint surface is not completely understood. Cadaver knees were evaluated with microcomputed tomography analysis for these variations. Objective differences were compared between: medial vs. lateral compartments; femoral vs. tibial bone; and normal vs. arthritic knees. Depth dependent changes in the parameters were observed for the first 6 mm of the cores in normal knees: BV/TV, Tb.N and Conn.D gradually decrease, while Tb.Sp and SMI increase. In the first 6 mm of the normal tibia BV/TV, Tb.N, and Tb.Th are greater than in the femur on both the medial and lateral compartments while Tb.Sp, SMI, and Conn.D are lower. The medial compartment values for BV/TV, Tb.N, Tb.Th and Conn.D are generally greater than for the lateral in both the femur and tibia while Tb.Sp and SMI are lower. In comparison of normal vs. arthritic knees significant differences are observed in the first 6 mm of the medial tibia. With arthritis BV/TV and Tb.Th are lower, while SMI and Tb.Sp are higher. Tb.N and Conn.D show no statistically significant difference. The bone structure variations are, thus, most prominent in the first 6 mm of depth and medial compartment bone is generally more structurally sound than lateral. Severely arthritic bone changes are most prominent in the medial compartment of the tibia and bone structure is less sound in severe arthritis.

Histomorphometric analysis of the proximal portion of the femur in dogs with osteoarthritis

OBJECTIVE

To describe cancellous architecture of the proximal portion of the femur in dogs with osteoarthritis.

ANIMALS

30 dogs with coxofemoral osteoarthritis.

PROCEDURE

All dogs had femoral head and neck excision or total hip arthroplasty. Histomorphometry software was used to analyze computer images of 100-microm-thick coronal and transverse plane sections of the head and neck of the femur. Histologic preparations of coronal and transverse sections of articular cartilage were graded.

RESULTS

Bone volume/total volume, trabecular thickness, trabecular number, and bone surface/total volume were significantly higher in the femoral head than femoral neck. Trabecular alignment (anisotropy) and separation were significantly higher in the femoral neck than femoral head. Anisotropy was significantly increased in the medial portion of the femoral head in the coronal plane and in the cranial portion of the femoral neck in the transverse plane, compared with healthy dogs. The medial half of femoral head cartilage that overlies the proximomedial cancellous bone region had significantly more degraded cartilage than the lateral half. Histologic grades for cranial and caudal halves of femoral head articular cartilage were similar.

CONCLUSIONS AND CLINICAL RELEVANCE

Most findings were similar to those in healthy dogs. Greater trabecular alignment in the proximomedial region of the femoral head and craniolateral region of the femoral neck in dogs with osteoarthritis suggests an altered transfer of load through the coxofemoral joint. Greater cartilage degradation on the medial half of the femoral head supports an association between increased trabecular alignment and cartilage degradation.

Histomorphometric analysis of the proximal portion of the femur in healthy dogs

OBJECTIVE

To describe the cancellous bone architecture of the head and neck of the femur in healthy dogs by use of automated histomorphometry techniques in conjunction with histologic grading of articular cartilage.

ANIMALS

30 mature male dogs with healthy coxo-femoral joints

PROCEDURE

Dogs were 1.5 to 4 years old and weighed 27 to 37 kg. Computer images of fine-detail radiographs of 100-microm-thick coronal and transverse plane sections of the head and neck of the femur (14 dogs) were analyzed by use of histomorphometry software. Statistical comparisons among histomorphometric indices of 4 regions were performed. Histologic preparations of coronal and transverse plane sections of femoral head articular cartilage (16 dogs) were graded. Median grades for lateral, medial, cranial, and caudal halves of the femoral head articular cartilage were determined.

RESULTS

Bone volume/total volume, trabecular thickness and number, and bone surface/total volume were significantly higher in the femoral head than in the femoral neck. Anisotropy (trabecular alignment) and trabecular separation were significantly higher in the femoral neck than in the femoral head. Anisotropy was significantly higher in the caudal half of the femoral neck than in the cranial half. Cartilage had histologic grades indicating health without significant differences among lateral, medial, cranial, and caudal halves of femoral head cartilage.

CONCLUSIONS AND CLINICAL RELEVANCE

A predictable cancellous architecture in the head and neck of the femur is associated with healthy cartilage.

Technical note: CT determination of the mineral density of dry bone specimens using the dipotassium phosphate phantom

Recent studies have demonstrated the potential application of computed tomography (CT) in research into bone density. Clinical studies of bone density using CT commonly employ a dipotassium phosphate phantom to calibrate measurements of mineral density. Designed for in vivo studies, the use of this phantom requires that bones be scanned while immersed in and permeated by fluids or soft tissues similar to water in X-ray attenuation coefficient. However, this condition may not always be met in anthropological applications, which often involve rare and fragile specimens. This study compares mineral density values calculated for a sample of bones scanned-at the same sites-in air and in water. The results indicate that, when scanned in air, the mineral density of trabecular bone is dramatically underestimated, while that of cortical bone is slightly overestimated. We present a linear regression equation to correct this error but recommend that, when possible, researchers calculate their own regressions based on their specific scanning conditions.

Volumetric quantitative computed tomography of the proximal femur: precision and relation to bone strength

We have developed a three-dimensional computed tomography (CT) scanning and image analysis method for measurement of trabecular and integral bone mineral density (BMD) and geometry in automatically determined femoral-neck and trochanteric subregions of the proximal femur. We measured the correlation of the density and geometry variables to femoral strength assessed in vitro under loading simulating a single-limb condition and a fall to the side. While BMD alone accounted for 48%-77% of the variability in strength for the stance loading configuration, femoral neck cross-sectional area (minCSA) and femoral neck axis length (FNAL) also contributed independently to femoral strength, and a combination of BMD and geometry variables explained 87%-93% of the variance in the data. For the fall loading configuration, trochanteric trabecular BMD alone explained 87% of the variability of strength. The reproducibility in vivo of the technique was assessed in a group of seven postmenopausal women, who underwent repeat scans with repositioning. For trabecular BMD, the precision was 1.1% and 0.6% for the femoral neck and trochanteric subregions, respectively, compared to 3.3% and 1.6% for the corresponding integral envelopes. Thus, trabecular BMD measurements were reproducible and highly correlated to biomechanical strength measurements. These results support further exploration of quantitative CT for assessment of osteoporosis at the proximal femur.