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Relación entre la edad, la estabilidad cortical del cuello femoral y el riesgo de fractura de cadera
Paul M Mayhew1, C David Thomas, John G Clement
1Department of Medicine, University of Cambridge, Cambridge, UK.
Lancet (London, England)
|July 12, 2005
Resumen
El envejecimiento aumenta el riesgo de fractura de cadera debido al adelgazamiento de la corteza del cuello femoral, especialmente en las mujeres. La carga insuficiente de caminar puede requerir ejercicios específicos para fortalecer los huesos y evitar caídas.
Área de la Ciencia:
- La ortopedia es la ortopedia.
- La biomecánica es la biomecánica.
- Gerontología Gerontología.
Sus antecedentes:
- El riesgo de fractura de cadera aumenta dramáticamente con la edad, siendo la torcedura local (inestabilidad elástica) una causa potencial.
- La estructura ósea se adapta a la carga mecánica; la subcarga del cuello femoral superolateral en el bipedalismo puede conducir al adelgazamiento cortical.
- Investigar los cambios relacionados con la edad en la inestabilidad elástica es crucial para comprender los desencadenantes de la fractura de cadera.
Objetivo del estudio:
- Para medir el aumento relacionado con la edad en la inestabilidad elástica en el cuello femoral.
- Para determinar si los cambios relacionados con la edad en la estructura ósea contribuyen al riesgo de fractura de cadera.
Principales métodos:
- La tomografía computarizada (TC) se utilizó para analizar la distribución ósea en el cuello femoral medio de 77 fémuros proximales de individuos de 20 a 95 años.
- El estrés crítico, un umbral para la inestabilidad elástica, se calculó en función de las propiedades geométricas y la densidad de la región ósea cortical más cargada.
Principales resultados:
- El envejecimiento normal condujo a un adelgazamiento significativo de la corteza del cuello femoral superoposterior, particularmente en las mujeres, con un espesor que disminuyó en un 6,4% por década.
- El estrés crítico disminuyó en un 13,2% por década en las mujeres, lo que indica una mayor susceptibilidad a la inestabilidad elástica.
- Este adelgazamiento relacionado con la edad redujo la capacidad de absorción de energía del fémur, independientemente de la osteoporosis, y los pacientes con fractura de cadera mostraron una mayor inestabilidad.
Conclusiones:
- El envejecimiento aumenta la fragilidad de la cadera en las mujeres debido a la subcarga de la corteza superolateral, lo que lleva a un adelgazamiento atrófico.
- Caminar puede no cargar lo suficiente el cuello femoral superior, lo que sugiere la necesidad de ejercicios de fortalecimiento.
- Las intervenciones dirigidas al ejercicio podrían mitigar potencialmente la fragilidad ósea relacionada con la edad y reducir la incidencia de fracturas de cadera.
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