Load distribution in the healthy and osteoporotic human proximal femur during a fall to the side

Due to remodeling of bone architecture, an optimal structure is created that minimizes bone mass and maximizes strength. In the case of osteoporotic vertebral bodies, however, this process can create over-adaptation, making them vulnerable for non-habitual loads. In a recent study, micro-finite element models of a healthy and an osteoporotic human proximal femur were analyzed for the stance phase of gait. In the present study, tissue stresses and strains were calculated with the same proximal femur micro-finite element models for a simulated fall to the side onto the greater trochanter. Our specific objectives were to determine the contribution of trabecular bone to the strength of the proximal femurs for this non-habitual load. Further, we tested the hypothesis that the trabecular structure of osteoporotic bone is over-adapted to habitual loads. For that purpose, we calculated the load distributions and estimated the apparent yield and ultimate loads from linear analyses. Two different methods were used for this purpose, which resulted in very similar values, all in a realistic range. Distributions of maximal principal strain and effective strain in the entire model suggest that the contributions to bone strength of the trabecular and cortical structures are similar. However, a thick cortical shell is preferred over a dense trabecular core in the femoral neck. When the load applied to the osteoporotic femur was reduced to approximately 61% of the original value, strain distributions were created similar in value to those obtained for the healthy femur. Since a comparable reduction factor was found for habitual load cases, it was concluded that the osteoporotic femur was not 'over-adapted'.