Aging changes in thickness of the proximal femoral cortex

This study explores age-related thinning of cortical bone in an area of the femur that is becoming of increasing clinical interest. It is based on measurements of medial-lateral and posterior-anterior radiographs of the proximal one-third of the right femur, below the greater trochanter. The study population consisted of 458 skeletons from the Terry collection and included approximately equal numbers of blacks and whites, males and females, age 20 to 98 years. Cortical thicknesses were measured at 11 levels, beginning with a line drawn perpendicular to the linea aspera at the level of the inferior border of the greater trochanter. The four quandrants (medial, lateral, anterior, posterior) differed in amount of change with age. In general, except for the relatively thick medial cortex, intertrochanteric levels showed less change than subtroachanteric levels. It is postulated that this is because the greatest remodeling activity takes place in trabecular rather than cortical bone in the intertrochanteric region. The anterior and posterior cortex showed the most regular and greatest amount of thinning with age. In males at lower levels, there was little or no loss in either medial or lateral cortex, but females showed considerable loss after the sixth decade. It is suggested that a stress-related "maintenance" factor retards cortical thinning in these quadrants. A review of the literature suggests that age-related cortical loss in the femur may have been accelerated in archaeological population, compared with modern groups.