A1 Journal article (refereed)
Effect of fall direction on the lower hip fracture risk in athletes with different loading histories : A finite element modeling study in multiple sideways fall configurations (2022)

Abe, S., Kouhia, R., Nikander, R., Narra, N., Hyttinen, J., & Sievänen, H. (2022). Effect of fall direction on the lower hip fracture risk in athletes with different loading histories : A finite element modeling study in multiple sideways fall configurations. Bone, 158, Article 116351. https://doi.org/10.1016/j.bone.2022.116351

JYU authors or editors

Publication details

All authors or editors: Abe, Shinya; Kouhia, Reijo; Nikander, Riku; Narra, Nathaniel; Hyttinen, Jari; Sievänen, Harri

Journal or series: Bone

ISSN: 8756-3282

eISSN: 1873-2763

Publication year: 2022

Volume: 158

Article number: 116351

Publisher: Elsevier Inc.

Publication country: United States

Publication language: English

DOI: https://doi.org/10.1016/j.bone.2022.116351

Publication open access: Openly available

Publication channel open access: Partially open access channel

Publication is parallel published (JYX): https://jyx.jyu.fi/handle/123456789/80174


Physical loading makes bones stronger through structural adaptation. Finding effective modes of exercise to improve proximal femur strength has the potential to decrease hip fracture risk. Previous proximal femur finite element (FE) modeling studies have indicated that the loading history comprising impact exercises is associated with substantially higher fracture load. However, those results were limited only to one specified fall direction. It remains thus unclear whether exercise-induced higher fracture load depends on the fall direction. To address this, using magnetic resonance images of proximal femora from 91 female athletes (mean age 24.7 years with >8 years competitive career) and their 20 non-athletic but physically active controls (mean age 23.7 years), proximal femur FE models were created in 12 different sideways fall configurations. The athletes were divided into five groups by typical loading patterns of their sports: high-impact (H-I: 9 triple- and 10 high-jumpers), odd-impact (O-I: 9 soccer and 10 squash players), high-magnitude (H-M: 17 powerlifters), repetitive-impact (R-I: 18 endurance runners), and repetitive non-impact (R-NI: 18 swimmers). Compared to the controls, the FE models showed that the Hsingle bondI and R-I groups had significantly (p < 0.05) higher fracture loads, 11–17% and 22–28% respectively, in all fall directions while the Osingle bondI group had significantly 10–11% higher fracture loads in four fall directions. The H-M and R-NI groups did not show significant benefit in any direction. Also, the analyses of the minimum fall strength (MFS) among these multiple fall configurations confirmed significantly 15%, 11%, and 14% higher MFSs in these impact groups, respectively, compared to the controls. These results suggest that the lower hip fracture risk indicated by higher fracture loads in athletes engaged in high impact or repetitive impact sports is independent of fall direction whereas the lower fracture risk attributed to odd-impact exercise is more modest and specific to the fall direction. Moreover, in concordance with the literature, the present study also confirmed that the fracture risk increases if the impact is imposed on the more posterolateral aspect of the hip. The present results highlight the importance of engaging in the impact exercises to prevent hip fractures and call for retrospective studies to investigate whether specific impact exercise history in adolescence and young adulthood is also associated with lower incidence of hip fractures in later life.

Keywords: bone fractures; hip; falling over; bone; Three-dimensional imaging; finite element method; athletes; types of sports; training

Free keywords: hip fracture; bone strength; fracture prevention; exercise; finite element modeling; fall

Contributing organizations

Ministry reporting: Yes

Reporting Year: 2022

JUFO rating: 2

Last updated on 2023-30-08 at 08:37