Physical Activity for Strengthening Fracture Prone Regions of the Proximal Femur

Fuchs, Robyn K.; Kersh, Mariana E.; Carballido‐Gamio, Julio; Thompson, William R.; Keyak, Joyce H.; Warden, Stuart J.

doi:10.1007/s11914-017-0343-6

Cited by 22 publications

(20 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is in line with available data on other athletic populations showing that exercise is capable of inducing BMD gains in both cortical and trabecular areas (Ireland, et al, 2013;Wilks, et al, 2009). It has also been reported that femoral neck strength at the superolateral area is the most relevant in fall-related fractures (Fuchs et al, 2017). Our professional dancers revealed higher density in this area compared to controls, which might indicate reduced risk of fractures.…”

Section: Discussionsupporting

confidence: 67%

Cortical and trabecular bone analysis of professional dancers using 3D-DXA: a case–control study

Freitas

Amorim

Humbert³

et al. 2018

Journal of Sports Sciences

View full text Add to dashboard Cite

Given the lack of relevant data, the aim of this study was to examine femur cortical and trabecular bone in female and male professional ballet dancers. 40 professional ballet dancers and 40 sex- and age-matched non-exercising controls volunteered. Femoral bone density was scanned by dual-energy X-ray absorptiometry (DXA) scan. A 3D-DXA software was used to analyse trabecular and cortical bone. Anthropometry, maturation (Tanner staging), menstrual parameters (age at menarche and primary amenorrhea), energy availability and nutritional analysis (3-day record) were also assessed.Compared to non-exercising participants, dancers exhibited significantly higher volumetric density for integral, cortical and trabecular bone, and thicker cortex at the femur. Ballet dancers demonstrated lower body weight compared to controls (p < 0.01). Female dancers had their menarche later than controls, and the prevalence of primary amenorrhea were significantly higher in dancers than controls (p < 0.01). Dancer's energy availability was below the normal range (<30 kcal/kgFFM/day). Despite the presence of certain osteoporosis risk factors such as low energy availability, primary amenorrhoea and lower body weight, professional ballet dancers revealed higher bone density for both cortical and trabecular bone compartments compared to controls.

show abstract

Section: Discussionsupporting

confidence: 67%

Cortical and trabecular bone analysis of professional dancers using 3D-DXA: a case–control study

Freitas

Amorim

Humbert³

et al. 2018

Journal of Sports Sciences

View full text Add to dashboard Cite

show abstract

“…The proximal femur is a frequent target for physical activity–induced bone adaptation as osteoporotic fractures at this site are a significant cause of morbidity and mortality. A large body of evidence has demonstrated benefits of physical activity on proximal femur bone health; however, questions remain as to whether the benefits translate into an enhanced ability to resist fracture‐related loading …”

Section: Introductionmentioning

confidence: 99%

“…A large body of evidence has demonstrated benefits of physical activity on proximal femur bone health; (1)(2)(3) however, questions remain as to whether the benefits translate into an enhanced ability to resist fracture-related loading. (4) Any region of the proximal femur can fracture under the right loading conditions; however, femoral neck fractures are most concerning because they have the greatest risk for complication. Femoral neck fractures in the elderly typically occur due to a fall in a direction broadly classified as "sideways" and with impact on the greater trochanter.…”

Section: Introductionmentioning

confidence: 99%

Heterogeneous Spatial and Strength Adaptation of the Proximal Femur to Physical Activity: A Within-Subject Controlled Cross-Sectional Study

Warden

Carballido‐Gamio

Weatherholt

et al. 2019

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Physical activity (PA) enhances proximal femur bone mass, as assessed using projectional imaging techniques. However, these techniques average data over large volumes, obscuring spatially heterogeneous adaptations. The current study used quantitative computed tomography, statistical parameter mapping, and subject‐specific finite element (FE) modeling to explore spatial adaptation of the proximal femur to PA. In particular, we were interested in adaptation occurring at the superior femoral neck and improving strength under loading from a fall onto the greater trochanter. High/long jump athletes (n = 16) and baseball pitchers (n = 16) were utilized as within‐subject controlled models as they preferentially load their take‐off leg and leg contralateral to their throwing arm, respectively. Controls (n = 15) were included but did not show any dominant‐to‐nondominant (D‐to‐ND) leg differences. Jumping athletes showed some D‐to‐ND leg differences but less than pitchers. Pitchers had 5.8% (95% confidence interval [CI] 3.9%–7.6%) D‐to‐ND leg differences in total hip volumetric bone mineral density (vBMD), with increased vBMD in the cortical compartment of the femoral neck and trochanteric cortical and trabecular compartments. Voxel‐based morphometry analyses and cortical bone mapping showed pitchers had D‐to‐ND leg differences within the regions of the primary compressive trabeculae, inferior femoral neck, and greater trochanter but not the superior femoral neck. FE modeling revealed pitchers had 4.1% (95% CI 1.4%–6.7%) D‐to‐ND leg differences in ultimate strength under single‐leg stance loading but no differences in ultimate strength to a fall onto the greater trochanter. These data indicate the asymmetrical loading associated with baseball pitching induces proximal femur adaptation in regions associated with weight bearing and muscle contractile forces and increases strength under single‐leg stance loading. However, there were no benefits evident at the superior femoral neck and no measurable improvement in ultimate strength to common injurious loading during aging (ie, fall onto the greater trochanter), raising questions as to how to better target these variables with PA. © 2019 American Society for Bone and Mineral Research.

show abstract

“…Greater associations of bone variables with cBPAQ than with tBPAQ may be due to differences between the patterns of bone-relevant physical activity in adulthood and youth and differences in maturation between sexes not equated in the formula of the tBPAQ (20). Higher activity according to the exposure to the mechanical load without taking into account either the type or direction of force may however not be sufficient to capture potential differences between specific bone regions induced by specific mechanical stimuli (18). Yet, the score obtained by each happens for all aBMDs assessed by DXA and usually is corrected having body height as covariate, as was done in this study.…”

Section: Accepted Manuscript 11mentioning

confidence: 99%

“…Other studies exploring regional adaptation of the femoral neck to physical exercise have identified heterogeneous adaptation, with adaptation principally occurring at the inferior, anterior, and posterior regions but not at the superior region of the femoral neck in young adult females athletes from distinct sports (16) or with small differences in the superior region in older men who participated in a home-based impact exercise intervention (unilateral hopping) during 12 months (17). Given the heterogeneity of the effects of physical activity/exercise on the proximal femur, it is necessary to identify programs capable of strengthening the regions that most predispose to hip fracture (18).…”

Section: Introductionmentioning

confidence: 99%

Adaptation of Proximal Femur to Mechanical Loading in Young Adults: Standard Vs Localized Regions Evaluated by DXA

Baptista

Lopes

Matute-Llorente

et al. 2020

Journal of Clinical Densitometry

View full text Add to dashboard Cite

Regions of the proximal femur with less adaptive protection by mechanical loading may be at increased risk of structural failure. Since the size and location of these ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T 2 regions diverge from those defined by the DXA manufacturers the purpose of this study was to compare areal bone mineral density (aBMD) of different regions of the proximal femur considering impact loads from physical activity (PA).The participants were 134 young adults divided into two groups according to the impact of PA performed in the last 12 months: high-impact PA (HPA) and low-impact PA (LPA). The aBMD of the proximal femur was assessed by DXA at the standard femoral neck (FN), intertrochanter, and trochanter, and at specific locations of the superolateral femoral neck (SFN) and intertrochanteric regions (ITR). The Bonespecific Physical Activity Questionnaire was used to estimate the impact load of PA.Comparisons between groups were adjusted for body height and body lean mass.Interaction analysis between sex and PA groups were conducted with ANCOVA.Comparisons of aBMD between bone regions were analyzed separately for men and women with repeated measures ANCOVA. In the HPA group, men benefit more than women at all bone regions, except the aBMD at ITR. Analyses of repeated measures did not reveal any significant interaction effect between bone regions (standard vs. specific) and PA groups (low vs. high-impact). In conclusion, aBMD differences due to mechanical loading were more pronounced in men than in women; the magnitude of the aBMD differences as a result of different levels of PA was similar between standard and localized regions.

show abstract

Physical Activity for Strengthening Fracture Prone Regions of the Proximal Femur

Cited by 22 publications

References 74 publications

Cortical and trabecular bone analysis of professional dancers using 3D-DXA: a case–control study

Cortical and trabecular bone analysis of professional dancers using 3D-DXA: a case–control study

Heterogeneous Spatial and Strength Adaptation of the Proximal Femur to Physical Activity: A Within-Subject Controlled Cross-Sectional Study

Adaptation of Proximal Femur to Mechanical Loading in Young Adults: Standard Vs Localized Regions Evaluated by DXA

Contact Info

Product

Resources

About