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Micro-computed tomography and mechanical evaluation of trabecular bone structure in osteopenic and osteoporotic fractures

Purpose: Osteopenia and osteoporosis are the two most common musculoskeletal disorders in the elderly population. We determined whether osteopenic and osteoporotic patients with fractures exhibit differences in trabecular morphology and biomechanical properties of bone. Methods: Fourteen osteopenic patients and 28 osteoporotic patients with hip fractures who underwent hemiarthroplasty for proximal femoral fractures caused by low-energy injury were included. Bone mineral density (BMD) measurements were performed. Compression tests and high-resolution micro-computed tomography were used to assess cancellous bone samples obtained from the principal compressive region of the femoral head. Results: The BMD values were lower in the osteoporotic patients than in the osteopenic patients (p < 0.05). There was a significant difference in the yield stress values between the groups (p < 0.05). However, no significant differences in the strain energy density, stiffness and Young’s modulus were observed between the groups (p > 0.05). The mean maximum stress was significantly higher in the osteoporotic patients than in the osteopenic patients (p < 0.05). Although structural parameters, including bone volume (BV), BV fraction, trabecular thickness, trabecular connectivity density and trabecular number, were higher in the osteopenic patients, the differences were not significant (p > 0.05). Trabecular separation values were significantly higher in the osteoporotic patients (p < 0.05). Conclusion: Our results showed that the trabecular morphology and biomechanical properties of bone were not significantly different between osteopenic and osteoporotic patients in terms of some parameters.