ArticleJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2008
Theoretical implications of the biomechanical fracture threshold.
Article in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Hip protectors for preventing hip fractures in older people.The Cochrane database of systematic reviews · 2014Pooled it
- Further reductions in nonvertebral fracture rate with long-term denosumab treatment in the FREEDOM open-label extension and influence of hip bone mineral density after 3 years.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2015Trial
- Teriparatide increases strength of the peripheral skeleton in premenopausal women with idiopathic osteoporosis: a pilot HR-pQCT study.The Journal of clinical endocrinology and metabolism · 2014Trial
- Femoral and vertebral strength improvements in postmenopausal women with osteoporosis treated with denosumab.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2014Trial
- Statistical shape modeling of the proximal femur in Mexican women: a cross-sectional morphometric and densitometric study.Archives of osteoporosis · 2026Article
- Fallville: A Perspective on an Interactive Pedagogical Tool to Enhance Understanding and Implementation of Fall-Compliant Flooring.Bioengineering (Basel, Switzerland) · 2026Article
- High rates of return-to-play and No deterioration in performance following ankle fractures in National Hockey League players.Journal of orthopaedics · 2025Article
- Biomechanical evaluation of a novel hockey-stick locking plate featuring a pes anserinus-sparing design: a finite element analysis.Frontiers in surgery · 2025Article
- Predicting soft tissue thicknesses overlying the iliac crests and greater trochanters of younger and older adults.PloS one · 2023Article
- Associations between bone attenuation and prevalent vertebral fractures on chest CT scans differ with vertebral fracture locations.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2021Article
- Finite element models for fracture prevention in patients with metastatic bone disease. A literature review.Bone reports · 2020Review
- Radiofrequency echographic multi-spectrometry for the in-vivo assessment of bone strength: state of the art-outcomes of an expert consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).Aging clinical and experimental research · 2019Article
- Vertebral Imaging in the Diagnosis of Osteoporosis: a Clinician's Perspective.Current osteoporosis reports · 2017Review
- The use of bone mineral density measured by dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed microtomography in chronic kidney disease.Journal of nephrology · 2017Review
- Differences in bone quality and strength between Asian and Caucasian young men.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2017Article
- Denosumab for Male Hemodialysis Patients with Low Bone Mineral Density: A Case-Control Study.International journal of nephrology · 2017Article
- Bone and Mineral Metabolism: Where Are We, Where Are We Going, and How Will We Get There?The Journal of clinical endocrinology and metabolism · 2016Article
- Trabecular bone score in kidney transplant recipients.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2016Article
- A biomechanical sorting of clinical risk factors affecting osteoporotic hip fracture.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2016Review
- Prophylactic augmentation of the osteoporotic proximal femur-mission impossible?BoneKEy reports · 2016Review
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2 authors.
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Abstract
Because of the dichotomous nature of a bone fracture, when Phi, the ratio of the applied impact force to the bone strength, is greater than a critical value--the biomechanical fracture threshold--fracture should occur. We sought to elucidate the conceptual implications of this biomechanical fracture threshold with application to hip fracture. We used data from the PaTH study, a 2-yr clinical trial in postmenopausal women treated with alendronate, PTH, or their combination. Outcomes included the force applied to the hip in a sideways fall as estimated from subject height and weight; femoral strength as determined by QCT-based finite element analysis; the load-to-strength ratio Phi; and total hip areal BMD from DXA. Results indicated that those with "very low" femoral strength (<2000 N) invariably had load-to-strength ratio Phi values well above the theoretical biomechanical fracture threshold (Phi = 1), but those with "moderately low" femoral strength (2000-4000 N) displayed Phi values both above and below the theoretical biomechanical fracture threshold. This finding implies that the risk of a hip fracture can be high in those with only moderately low BMD because femoral strength can be low relative to fall impact forces. The observed weak correlation between areal BMD and the load-to-strength ratio Phi (r2 = 0.14) suggests that consideration of the biomechanical fracture threshold may improve fracture risk assessment, particularly for those in the osteopenic range. Regarding treatment effects, only those subjects having load-to-strength ratio Phi values within a relatively narrow "transition zone" of +/- 20% of the assumed biomechanical fracture threshold at baseline were predicted to change fracture status during the trial. In theory, outcomes of fracture trials may be dominated by the responses of those within the "transition zone" at baseline, and treatment benefits in terms of fracture efficacy may depend the patient's baseline status with respect to the biomechanical fracture threshold. We conclude that consideration of the theoretical implications of the biomechanical fracture threshold may lead to new insights and advances in the assessment and treatment of osteoporosis.
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