Fractures of the proximal femur represent a significant health concern especially in the elderly. Fatigue damage and microfractures have been implicated in the etiology of hip fractures; however, the extent to which these factors are sufficient to bring about significant reductions in proximal femur strength and stiffness is unknown. This study examined the hypothesis that fatigue loading of the proximal femur results in highly correlated decreases in bone stiffness and strength through the accumulation of bone microdamage. One canine femur from each of 10 pairs was monotonically loaded to failure to determine the ultimate strength. The contralateral femur was then cyclically loaded at 50% of the ultimate load value for either 3600 cycles or until a 40% reduction in stiffness was achieved. This femur was then monotonically loaded to failure. For two additional femur pairs, the fatigued femur was histologically processed to reveal bone microdamage. In support of the hypothesis, the data demonstrated a linear relationship between strength loss and stiffness loss (Adj. R² = 0.79, P < 0.0004) with significant decreases in residual whole bone strength (p < 0.004) following cyclic loading. In addition, damage (microcracks) in the cortical bone and broken trabeculae were observed in the neck and head region of the femur fatigued until its stiffness was reduced by 40% but not fractured subsequent to cyclic loading.
Keywords: Fatigue; Microdamage; Femoral neck; Ultimate strength; Residual strength; Residual stiffness