Effect of PMMA Bone Cement Augmentation on the In Vitro Fracture Load of the Osteoporotic Proximal Femur

Fractures of the hip are an important public healthcare concern and a major source of mortality and morbidity among the elderly. In 1990, an estimated 1.66 million hip fractures occurred throughout the world (Cooper, Campion et al. 1992), frequently resulting in functional limitations, reduced quality of life, social dependency, and a major increase of mortality within one year of injury (Keene, Parker et al. 1993; Barrett-Connor 1995; Johnell 1997). Continued growth in the elderly population will raise the incidence of hip fractures and their associated costs dramatically: It has been suggested that the incidence of hip fractures will increase to approximately 6.26 million worldwide by the year 2050 (Cooper, Campion et al. 1992). The majority of hip fractures among the elderly are thought to be primarily related to osteoporosis (Lewinnek, Kelsey et al. 1980; Melton, Wahner et al. 1986), a systemic skeletal disease which is characterized by the marked reduction in bone mineral density (BMD) and the microarchitectural deterioration of bone tissue (Consensus Development Conference, 1993). Efforts to maintain or increase bone mass in osteoporotic patients are currently based on systemic drug therapy (e.g., bisphosphonates, calcium, calcitonine, calcitriol, fluorides, hormone replacement therapy, selective estrogen receptor modulators). In the elderly, however, pharmacological trials demonstrated only modest increases in femoral neck BMD.