Cortical thinning measured in vivo: key determinant of hip fracture risk

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In recent work we demonstrated an unmet need for measuring cortical thickness accurately in the thin posterior part of the supero-lateral (SL-P) femoral neck. This is the likely site of initiation of the crack that spreads with lightning speed to generate most hip fractures. Employing a new in vivo method for correcting measurements of thickness of thin cortices that are currently biased by the partial volume effect in computed tomography, we shall test the in vivo method?s ability to show the 50% reduction in thickness of the SL(P) cortex with age revealed by Mayhew?s recent (ex-vivo) study. We shall cross-calibrate the method against better-resolution CT technology with ex-vivo femur samples, examine the stabilizing role of trabeculae and measure reproducibility. We shall then assess normal variation in cortical thickness along the femoral neck axis in a population of hospital referrals with normal whole body CT scans. This is in preparation for measuring femoral cortical thickness in future studies of hip fracture epidemiology and clinical trials of new interventions. With this application we shall provide new methodology for use in clinical osteoporosis studies that are needed to combat the devastating effects of hip fracture in our ageing population.