Structural Trends in the Aging Femoral Neck and Proximal Shaft: Analysis of the Third National Health and Nutrition Examination Survey Dual‐Energy X‐Ray Absorptiometry Data

• Published in: Journal of bone and mineral research Vol. 15; no. 12; pp. 2297 - 2304
• Main Authors: Beck, Thomas J., Looker, Anne C., Ruff, Christopher B., Sievanen, Harri, Wahner, Heinz W.
• Format: Journal Article
• Language: English
• Published: Washington, DC John Wiley and Sons and The American Society for Bone and Mineral Research (ASBMR) 01.12.2000; American Society for Bone and Mineral Research
• Subjects: Absorptiometry, Photon; Adult; Age Factors; age trends; Aged; Aged, 80 and over; Biological and medical sciences; Bone Density; bone mass; Confounding Factors (Epidemiology); European Continental Ancestry Group; Femur - anatomy & histology; Femur Neck - anatomy & histology; Fundamental and applied biological sciences. Psychology; Health Surveys; hip structural geometry; Humans; Male; Middle Aged; section modulus; Sex Factors; Skeleton and joints; Space life sciences; subperiosteal expansion; United States; Vertebrates: osteoarticular system, musculoskeletal system; United States; North America; America; Human; Femoral neck; Proximal; Senescence; Density; Inorganic element; Epidemiology; Hip; Osteoarticular system; X ray absorption spectrometry; Bone mass; Dual energy absorptiometry; Adult; Bone; Elderly; Public health
• ISSN: 0884-0431; 1523-4681
• DOI: 10.1359/jbmr.2000.15.12.2297

Hip scans of U.S. adults aged 20–99 years acquired in the Third National Health and Nutrition Examination Survey (NHANES III) using dual‐energy X‐ray absorptiometry (DXA) were analyzed with a structural analysis program. The program analyzes narrow (3 mm wide) regions at specific locations across the proximal femur to measure bone mineral density (BMD) as well as cross‐sectional areas (CSAs), cross‐sectional moments of inertia (CSMI), section moduli, subperiosteal widths, and estimated mean cortical thickness. Measurements are reported here on a non‐Hispanic white subgroup of 2719 men and 2904 women for a cortical region across the proximal shaft 2 cm distal to the lesser trochanter and a mixed cortical/trabecular region across the narrowest point of the femoral neck. Apparent age trends in BMD and section modulus were studied for both regions by sex after correction for body weight. The BMD decline with age in the narrow neck was similar to that seen in the Hologic neck region; BMD in the shaft also declined, although at a slower rate. A different pattern was seen for section modulus; furthermore, this pattern depended on sex. Specifically, the section modulus at both the narrow neck and the shaft regions remains nearly constant until the fifth decade in females and then declined at a slower rate than BMD. In males, the narrow neck section modulus declined modestly until the fifth decade and then remained nearly constant whereas the shaft section modulus was static until the fifth decade and then increased steadily. The apparent mechanism for the discord between BMD and section modulus is a linear expansion in subperiosteal diameter in both sexes and in both regions, which tends to mechanically offset net loss of medullary bone mass. These results suggest that aging loss of bone mass in the hip does not necessarily mean reduced mechanical strength. Femoral neck section moduli in the elderly are on the average within 14% of young values in females and within 6% in males.