Physical activity for strengthening fracture prone regions of the proximal femur

Fuchs, Robyn K.<sup>1,2</sup>; Kersh, Mariana E.<sup>3</sup>; Carballido-Gamio, Julio<sup>4</sup>; Thompson, William R.<sup>1</sup>; Keyak, Joyce H.<sup>1</sup>; Warden, Stuart J.<sup>1,2</sup>

Affiliations

¹Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN

²Center for Translational Musculoskeletal Research, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN

³Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, IL

⁴Department of Radiology, School of Medicine, University of Colorado Denver, Denver, CO

⁵Department of Radiological Sciences, University of California, Irvine, CA

⁶Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA

⁷Department of Biomedical Engineering, University of California, Irvine, CA

Abstract and keywords

Purpose of review: Physical activity improves proximal femoral bone health; however, it remains unclear whether changes translate into a reduction in fracture risk. To enhance any fracture-protective effects of physical activity, fracture prone regions within the proximal femur need to be targeted.

Recent findings: The proximal femur is designed to withstand forces in the weight bearing direction, but less so forces associated with falls in a sideways direction. Sideways falls heighten femoral neck fracture risk by loading the relatively weak superolateral region of femoral neck. Recent studies exploring regional adaptation of the femoral neck to physical activity have identified heterogeneous adaptation, with adaptation principally occurring within inferomedial weight bearing regions and little to no adaptation occurring in the superolateral femoral neck.

Summary: There is a need to develop novel physical activities that better target and strengthen the superolateral femoral neck within the proximal femur. Design of these activities may be guided by subject-specific musculoskeletal modeling and finite element modeling approaches.

Keywords: bone density; bone mass; bone structure; exercise; femoral neck; osteoporosis

Links

DOI: 10.1007/s11914-017-0343-6

PubMed: 28133707

PubMedCentral: PMC5317179

WoS: 000394447700006

History

Online: 2017-01-30

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Cited By (7)

Year	Entry
2019	Warden SJ, Carballido-Gamio J, Avin KG, Kersh ME, Fuchs RK, Krug R, Bice RJ. Adaptation of the proximal humerus to physical activity: a within-subject controlled study in baseball players. Bone. 2019;121:107-115.
2020	Keyak JH, Kaneko TS, Khosla S, Amin S, Atkinson EJ, Lang TF, Sibonga JD. Hip load capacity and yield load in men and women of all ages. Bone. August 2020;137:115321.
2024	Cramer EEA, de Wildt BWM, Hendriks JGE, Ito K, Hofmann S. Integration of osteoclastogenesis through addition of PBMCs in human osteochondral explants cultured ex vivo. Bone. January 2024;178:116935.
2018	Kersh ME, Martelli S, Zebaze R, Seeman E, Pandy MG. Mechanical loading of the femoral neck in human locomotion. J Bone Miner Res. November 2018;33(11):1999-2006.
2020	Warden SJ, Carballido‐Gamio J, Weatherholt AM, Keyak JH, Yan C, Kersh ME, Lang TF, Fuchs RK. Heterogeneous spatial and strength adaptation of the proximal femur to physical activity: a within‐subject controlled cross‐sectional study. J Bone Miner Res. April 2020;35(4):681-690.
2023	Prince R, Khoo B, Brown K, Lewis J. Differences in femoral neck and trochanteric structure in elderly women prior to hip fracture: role in hip fracture prediction. J Bone Miner Res. June 2023;38(6):869-875.
2019	Harding A. LIFTMOR-M: Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation for Men [PhD thesis]. Brisbane, Australia: Griffith University; December 2019.