Correlation of femoral and lumbar DXA and calcaneal ultrasound, measured in situ with intact soft tissues, with the in vitro failure loads of the proximal femur

The objective of this study was to determine experimentally the sex-specific correlation of femoral and lumbar DXA and calcaneal ultrasound, measured in situ, with the in vitro failure loads of the proximal femur. Fifty-eight cadavers with intact skin and soft tissues (34 male, aged 81.2 +/- 8.7 years; 24 female, aged 83.7 +/- 10.6 years) were examined. The bone mass of the proximal femur and the lumbar spine were determined using dual-energy X-ray absorptiometry and the ultrasonic properties of the calcaneus with quantitative ultrasound. Afterwards, the right femora were excised 18 cm distal to the minor trochanter, and their load to failure determined with a material testing machine. Femoral fracture loads were significantly higher in males than in females, both before and after correcting for body height and weight. Femoral neck bone mineral density (BMD) was significantly correlated with femoral failure loads (r=0.65 all specimens, 0.57 males (0.64 after excluding trochanteric fractures) and 0.77 females; p <0.001). The correlations with the ultrasonic Stiffness Index of the calcaneus were in a similar range (r = 0.67 all specimens, 0.48 males (0.64 after excluding trochanteric fractures) and 0.65 females; p <0.001). The correlations between femoral failure loads and the spinal BMD were lower (r=0.40, p <0.01), particularly in males (r=0.30, not significant). In contrast to previous experimental investigations on excised bones, our results are consistent with clinical studies that have reported that ultrasound and femoral DXA have a similar ability to predict the risk of hip fracture.