A novel mechanism for induction of increased cortical porosity in cases of intracapsular hip fracture

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Bell, K. L.¹; Loveridge, N.¹; Jordan, G. R.¹; Power, J.¹; Constant, C. R.²; Reeve, J.¹

A novel mechanism for induction of increased cortical porosity in cases of intracapsular hip fracture

Bone. August 2000;27(2):297-304

©2000 Elsevier Science Inc. All rights reserved.

Affiliations

¹Bone Research Group (MRC), Department of Medicine, University of Cambridge, Cambridge, UK

²Department of Orthopaedics, Addenbrooke’s Hospital, Cambridge, UK
Abstract and keywords

It has been suggested that, in hip fracture, the cortex on the inferoanterior (IA) to superoposterior (SP) axis is thinned and shows increased porosity. This is dependent on the presence of giant canals (i.e., diameter >385 μm), which are related to clusters of remodeling osteons. To investigate further the relationship between remodeling and bone loss, osteonal diameter (On.Dm), wall thickness (W.Th), osteoid width (O.Wi), and extent (OS) were measured in femoral neck biopsies from 12 female intracapsular hip fracture cases and 11 age- and gender-matched controls. Over 83% of giant canals were “composite” osteonal systems in which a single canal was surrounded by multiple packets of osteonal bone. Among smaller canals, over 80% of systems had a canal encircled by a single cement line containing one packet of bone (“simple”). Composites were nearly twice as prevalent in fractures (fracture cases 9.8 ± 0.7/25 mm2, controls 5.3 ± 0.4/25 mm2, p < 0.0001), and were dependent (R² = 0.52) on femoral neck region (p = 0.0008) and the regional distribution of clusters of remodeling osteons (p = 0.0045). Both the inferior (I) and anterior (A) regions had an elevated number of composites (I: 263% of control values, p = 0.0054; A: 202% of control values, p = 0.0092). On.Dm was similar in fracture cases and controls (simple: fracture cases 183 ± 3 μm, controls 191 ± 4 μm; composites: fracture cases 446 ± 13 μm, controls 460 ± 13 μm). W.Th in simples was similar in fracture cases and controls (fracture cases 51 ± 0.8 μm, controls 49 ± 0.7 μm), but composites had significantly (p < 0.0001) thinner walls, with the reduction in fracture cases (31%) being twice that of controls (12%, p < 0.0001). There were no differences in O.Wi. It was unusual for osteoid to fully surround the composite canal surface; OS was 38% lower in composite than simple canals (p < 0.0001). This study indicates that, in the femoral neck cortex, the principal remodeling deficit in hip fracture is specific to composite osteons. Hip fracture cases had zonal increases in composite osteon density with reduced bone formation. The data suggest that generation of composite osteons is a plausible mechanism leading to increasing porosity and trabecularization of the cortex, thus weakening the cortex in regions maximally loaded on fall impact.

Keywords: Cortical remodeling; Femoral neck; Intracapsular hip fracture; Haversian canals; Osteoporosis
Links

DOI: 10.1016/S8756-3282(00)00318-5

PubMed: 10913926

WoS: 000088489000018
History

Received: 2000-01-21

Revised: 2000-04-04

Accepted: 2000-04-04

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2018	Andreasen CM, Delaisse J-M, van der Eerden BCJ, van Leeuwen JPTM, Ding M, Andersen TL. Understanding age-induced cortical porosity in women: is a negative BMU balance in quiescent osteons a major contributor? Bone. December 2018;117:70-82.
2020	Andreasen CM, Bakalova LP, Brüel A, Hauge EM, Kiil BJ, Delaisse J-M, Kersh ME, Thomsen JS, Andersen TL. The generation of enlarged eroded pores upon existing intracortical canals is a major contributor to endocortical trabecularization. Bone. January 2020;130:115127.
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2018	Andreasen CM, Delaisse J, van der Eerden BCJ, van Leeuwen JPTM, Ding M, Andersen TL. Understanding age-induced cortical porosity in women: the accumulation and coalescence of eroded cavities upon existing intracortical canals is the main contributor. J Bone Miner Res. April 2018;33(4):606-620.
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