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. 2026 Feb 27;44(3):e70167. doi: 10.1002/jor.70167

Longitudinal Density and Volume Changes of Periacetabular Cancellous and Cortical Bone

Thomas Robertson 1,2,✉, Xiangyu Dong 2, John Abrahams 1,2, Bogdan Solomon 1,2, Rob Nelissen 3, Stuart Callary 1,2
PMCID: PMC12949342  PMID: 41761472

ABSTRACT

Longitudinal structural bone changes within the periacetabular region have potential implications for fracture risk as well implant or arthroplasty fixation within the pelvis. This study presents the first CT‐based longitudinal quantitative measurements of bone density and volume in a total of 235 patients. Each patient had a repeat pelvic CT performed > 10 years apart for various indications in South Australia's public hospitals. All slices of each scan were segmented and calibrated with Simpleware software. Cortical and cancellous bone density and volume were measured in defined periacetabular regions of interest. Pelvic bone volume remained constant with increase in age, but the volume of cortical bone decreased whilst the cancellous volume increased. Conversely, the density of cancellous bone decreased whilst cortical bone density increased with age. The patterns of bone loss correlate to bone remodeling due to preferential superomedial loading of the hip. The results also confirm reduced bone density of the anterior column with increasing age in keeping with susceptibility of the geriatric patient to anterior column acetabular fractures. The overall findings show that with time the periacetabular region develops a sclerotic thinner wall, which may be susceptible to fracture and when combined with reduced cancellous bone density potentially less amenable to implant fixation.

1. Introduction

Up to 77% of orthopedic surgeons use bone quality to plan their implant choice in hip arthroplasty, however, only 4% use quantitative bone assessments for this process [1]. Uncemented acetabular components, which are used in the majority of hip arthroplasties, rely on initial press fit fixation, with or without adjunct screw fixation, and as such require adequate bone quality and stock [2]. Whilst previous studies have measured changes in periacetabular density post hip replacement [3, 4], there is a paucity of literature on longitudinal changes in the native pelvis by age and gender. Notably, previous studies investigated native subchondral acetabular density in cohorts with cam‐type femoral lesions who are considerably younger than those undergoing hip arthroplasty or experiencing geriatric acetabular fractures [5, 6]. The large variability between individuals and effect of age‐related change on pelvic volume may be useful for preoperative planning of hip surgeries [7]. There has been an increased use of computer tomography (CT) imaging for clinical diagnostic purposes which allows opportunistic study of skeletal morphological changes over time in individuals who have undergone repeat examinations. CT‐based linear measurements of pelvic morphometry have previously been shown to be accurate [8, 9, 10, 11, 12].

Bone remodeling is a lifelong process that affects not only its density but also its outer morphology [13, 14, 15]. The bone density changes in the spine and neck of femur have been previously investigated resulting in clinical improvements toward the management of osteoporosis [16]. For example, an increase in cortical bone thickness in osteoporotic patients can improve bending strength and is protective of fracture in the neck of the femur region [17, 18, 19], while previous segmental quantitative CT studies have found that reduced cortical thickness, particularly in the anterior superior femoral neck, is predictive of future fracture [20]. Reduction in both cancellous and cortical bone volume can make the bone susceptible to fracture under the load of the femoral neck [21].

Reduced bone density or osteoporosis has multiple risk factors including age, gender, weight, load bearing physical activity, and secondary medical causes. The changes in adult bone outer morphometry and density over time in the periacetabular region have not been studied in as much detail even though they are likely to change with age and reduced loading. Wolff's law dictates that bone will adapt to the degree of mechanical loading and as such, the architecture of the pelvic bone is affected by the mechanical force distributed through the hip joint [22]. It is likely that different cortical and cancellous bone distribution, thickness and density could make patients susceptible to geriatric acetabular fractures, similar to neck of femur fractures. The incidence of geriatric acetabular fractures has been reported to increase 2.4 times in the last three decades, which is attributed to the aging population [23, 24]. Surgical treatment of geriatric acetabular fractures can be challenging due to poor pelvic bone stock and is associated with a high mortality rate of 24% within the first year and a 20% reoperation rate [25, 26]. CT assessment at the time of injury is standard of care for complex surgical planning and may be useful for preoperatively identifying bone quality, however, little is known about the expected native periacetabular density.

Given the paucity of knowledge regarding the changes in native periacetabular bone density and the clinical implications in arthroplasty and the treatment of geriatric acetabular fractures, the primary aim of the present study was to investigate longitudinal age and sex related changes in cancellous and cortical bone density over at least 10 years in periacetabular zones using CT scans. The secondary aim was to measure longitudinal morphometry of the pelvis in CT scans of patients over 10 years apart.

2. Methods

All digital CT scans that included the pelvis performed in patients older than 18 years were identified from the Picture Archive and Communication system (PACS) database of all South Australian public hospitals between 2003 and 2024. Inclusion criteria were CT scans that were repeated in the same subject after an interval of over 10 years in the absence of any bony pathology. Exclusion criteria were incomplete scans of the pelvis, scans with an axial thickness > 3 mm, or the presence of bone implants in situ. The age and sex of each patient, and the time interval between scans was documented. The CT data (formatted in DICOM standard) were retrieved from PACS and downloaded deidentified into Simpleware (Synopsys, Sunnyvale, California, USA) for analysis.

The automated CT measurement technique used Simpleware software to automatically determine bone volume using the thresholding function to identify the bony outline similar to a previous study using Simpleware to quantify bone density regions of interest [27]. The software contains preset hip references to identify pertinent pelvic landmarks and calculate the volume within the bone's outer shell (surface volume). Regions of interest in the acetabulum were identified. These regions are areas where an uncemented acetabular component would be seated during surgery and were defined in previous work by the research group (Figure 1) [6]. Regions were split into 1 cm segments above and below the acetabulum with a further divide into quadrants above and halves below the acetabulum. The vertical zones were reduced to six compared with the previously described eight to reduce complexity in the analysis [6]. Cortical and cancellous bone density were measured separately within each region of interest. The cortical, cancellous, and total combined bone of the entire hemipelvis were also measured. Regions of interest were autosegmented using python code following manual selection of the axial slice representing the most cranial section of the acetabulum and the center of the femoral head as the reference for quadrants and anterior or posterior division (Figure 1).

Figure 1.

Figure 1

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(a) Segmentation of a hemipelvis. (b) Simpleware 3D reconstructions of masks. (c) Axial slice above the acetabulum. (d) Axial slice below the acetabulum. (e) Sagittal slice. (f) Coronal slice.

The software additionally measures the pelvic morphology via linear measurements of anatomical landmarks automatically recognized by the software during segmentation of the native bone. The following distances between specific anatomical landmarks on both sides of the pelvis were measured in millimeters: anterior superior iliac spine (ASIS), femoral head center (FH), greater trochanter (GT), lesser trochanter (LT), posterior superior iliac spine (PSIS), and pubic tubercle (PT) (Figure 2).

Figure 2.

Figure 2

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Linear morphometry analysis between anatomical landmarks automatically identified during pelvic bone segmentation. Each bone is segmented separately and rendered in a different color. Each landmark is written and indicated by a cross. Numbers indicate the position of the landmark in the X, Y, and Z axes relative to the center of the scan.

Volume was assessed for the entire hemipelvis. The bone volume above the acetabulum up to the anatomical landmark of the ASIS was also assessed and then separated into cortical and cancellous bone measurements (Figure 3).

Figure 3.

Figure 3

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Volume calculation from pelvic segmentation. (a) Cancellous bone segmentation, (b) cortical bone segmentation, and (c) combined cortical and cancellous segmentation.

2.1. Calibration

Calibration of CT scans with a phantom was not feasible as multiple different CT scan protocols had been used over the long study period for varying nonorthopedic indications. Therefore, grayscale and pixel counts for air, fat, and muscle were performed for all 235 patients in line with the Eggermont calibration method [28]. Air, fat, and muscle in the buttock were segmented using thresholding from 10 axial slices above the acetabulum. The peak of the histogram identified fat and muscle clearly in a bimodal distribution (Figure 4).

Figure 4.

Figure 4

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(a) Histogram with three peaks for air, fat, and muscle, showing a clear bimodal distribution. (b) Axial slice of with red outline of posterior lateral fat and muscle. (c) Coronal slice fat and muscle with red outline lateral muscle and fat. (d) Green segmented air, muscle, and fat in the sagittal view.

2.2. Statistical Analysis

Analysis was done on GraphPad Prism (GraphPad v10, Boston, MA, USA) and SPSS v29 (IBM, Illinois, USA) software packages. Data were assessed for normality with a Shapiro–Wilk test for normality and variables were compared using a paired t‐test. A multivariate regression analysis was performed to assess for confounding variables of age, gender, and time between scans on the volume and density measurements. Further statistical analysis was performed to assess the difference in cancellous bone density in patients greater than and below age of 70 at time of index scan. Seventy years was chosen as acetabular fractures have the highest prevalence in the 8th decade of life. A multivariate analysis was performed to determine if age, gender, and time between scans had an effect on volume.

2.3. Ethics

Ethical approval was sought from the local hospital network ethics board, the CALHN Human Research Ethics Committee (CALHN HREC Approval 20169).

3. Results

Scans form 235 patients matched the inclusion and exclusion criteria and were included for analysis in the study. There were 135 males and 100 females. The median age at the first scan was 54 years (43–65 IQR), median age at second scan was 67 years (56–78 IQR). The median time between scans was 13 years (range 10–20 years). Of the included CT scans, 54% were requested for CT of the kidney, ureter, bladder (KUB), 44% for CT abdomen/pelvis, and 2% for other protocols. All CT KUB scans utilized 120 kV protocols and 94% of the CT abdomen/pelvis scans utilized between 90 and 110 kV. Four CT scanners were utilized for almost all (99%) of the scans including Toshiba Aquillion, Toshiba Acquillion One, Siemens definitions AS, and Siemens force.

3.1. Bone Density Quantitative Measurements

The mean cancellous bone density decreased by 16% between follow‐up scans. The greatest decreases were seen inferiorly in both the posterior and anterior segments and laterally above the level of the acetabulum in the anterolateral region (Figure 5). An increase in cortical bone density was seen in the regions above the level of the acetabulum. The greatest increase in bone density was seen in the lateral areas (Figure 5), however, increases between 8% and 13% were seen in all areas, p ≤ 0.05.

Figure 5.

Figure 5

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Percentage difference between initial and follow‐up scans by ROI. Decreases of more than 10% are in orange, more than 15% in red, and increases more than 10% in green. The six periacetabular regions are marked from −3 to +3 as indicated on the 3D rendered image, where 0 represents the supracetabular ilium. AL = anterolateral; AM = anteromedial; PL = posterolateral; PM = posteromedial.

Mean cortical bone density measurements were highest in the posterior regions, particularly the posteromedial region above the level of the acetabulum. Mean cancellous measurements were highest anteriorly just below the top of the acetabulum then posteriorly above the level of the acetabulum with the exception posterior‐medially in the first region above (Figure 6).

Figure 6.

Figure 6

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Mean bone density for the included regions of interest at follow‐up (mg HA/cm3).

Females had a significantly greater increase in cortical bone density over time (34.6% vs. 16.2%, p = 0.032) and a significantly greater loss of cancellous bone density (−33.1% vs. 25.6%, p = 0.032) compared to their index scan. Increasing combined bone density loss was associated with increased age (p = 0.01). Older females were observed to have significant loss of bone above the level of the acetabulum in Regions 2 and 3 (p ≤ 0.05) This was evidenced by significant anterolateral cancellous bone density loss in females in all three supraacetabular regions (Figure 7). Females had greater cancellous bone loss below the level of the acetabulum for the anterior and posterior region −1 and just anterior for region −2 (Figure 7).

Figure 7.

Figure 7

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Significance of percentage density change between scans relating to gender (G) or age (A) if p < 0.05.

Assessment of change of cancellous bone density according to age showed that only one region of interest had a significant change in bone density (Table 1).

Table 1.

Subanalysis of > 70 (n = 37) and < 70 to assess for specific regions with cutoff for geriatric age values are in mg (HA/cm3).

Region of interest Mean for < 70 years Mean for ≥ 70 years Mean of difference p
Cancellous anterolateral ROI 1 −31.2 −41.3 −10.2 0.065
Cancellous anteromedial ROI 2 −14.5 −24.3 −9.9 0.080
Cancellous anteromedial ROI 3 −16.6 −38.4 −21.8 0.018
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Note: Of the 39 regions of interest examined only regions of interest that had a p value < 0.1 are shown.

3.2. Linear Pelvic Morphometry

The mean ASIS to ASIS distance was 232.1 mm and the mean interfemoral head distance was 173.5 mm on initial scan. There was no significant change in any measurement over time (Table 2).

Table 2.

The mean distance (mm) between left and right anatomical landmarks in the initial CT scan.

ASIS FH GT LT PSIS PT
Mean 232 174 261 182 86 53
SD 18.3 9.3 16.5 13.5 10.5 7.4
Mean difference −1.12 −0.27 −0.39 −0.43 0.58 −0.60
p 0.50 0.76 0.80 0.74 0.55 0.39
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Note: p value with paired t‐test.

Abbreviations: ASIS, anterior superior iliac spine; FH, femoral head center; GT, greater trochanter; LT, lesser trochanter; PSIS, posterior superior iliac spine; PT, pubic tubercle.

The volume of cancellous bone significantly increased on both sides of the pelvis. Cortical bone volume was observed to significantly decrease over time (Figure 8). The combined hemipelvis volume was constant with no significant (p < 0.05) change over time (Table 3).

Figure 8.

Figure 8

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Change of bone above the level of the acetabulum. (a) Volume analysis. Red indicates scans taken at the initial time point. Blue indicates scans taken at subsequent follow‐up. (b) The percentage change represented with yellow graph.

Table 3.

Volume of cancellous and cortical bone above the acetabulum to the level of the ASIS (mm3), whole hemipelvis.

Cancellous L Cancellous R Cortical L Cortical R Hemipelvis L Hemipelvis R
Mean 40,562 39,397 40,040 39,555 330,549 330,550
SD 14,777 14,922 12,456 12,821 65,486 65,542
Mean difference 2564 3276.9 −3951 −3745 1709 1124
p 0.04 0.02 0.001 0.003 0.78 0.88
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For cancellous bone, there was a nonsignificant effect between gender, age, and time between scans. p = 0.215 and 0.230 for left and right, respectively. For cortical bone, there was a significant effect between gender, age, and time between scans p = 0.029 and p = 0.023. Age was a significant independent factor for decreasing cortical volume.

4. Discussion

This study demonstrates that in the periacetabular bone region, cortical bone density increases while cortical bone volume decreases slightly over a mean 13‐year follow‐up in patients with an average age of 54 years at baseline. In contrast, cancellous bone volume increases but decreases in density with age. Linear bone measurements remained similar between scans. These changes in bone density and volume in the periacetabular region represent a new insight into the age‐related remodeling that produces a thin sclerotic bony rim housing a larger volume of low‐density cancellous bone. The sclerotic thin‐shelled pelvis in the periacetabular area with reduced cancellous bone density may render it more susceptible to fracture and less amenable to arthroplasty implant fixation. Our findings are consistent with the anecdotal surgical experience of the author group that have encountered reduced cancellous density and sclerotic thin cortices within the elderly patient.

This study is, to the authors' knowledge, the only longitudinal study of CT‐measured density changes within the native pelvis. Our study provides a detailed investigation of the changes in periacetabular bone density and volume, which are essential for acetabular bone fixation. The changes observed in the pelvis during aging may be explained by the loading patterns within the pelvis. Previous studies have shown that during weight‐bearing, there is an initial superolateral force that is distributed within the pelvis superiorly and posteromedially toward the sacroiliac joint [29]. This finding is supported by the present study, which demonstrated reduced anterior and lateral cancellous bone density with an increase in age. The thin‐walled cortex and reduced anterolateral cancellous bone density likely accounts for the frequency, etiology, and morphology of common geriatric anterior column fractures [30, 31]. The decrease in cortical bone thickness was correlated with age on the multivariate analysis. The reduced cancellous bone density observed just below the top of the acetabulum and in the zones above the acetabulum correlated with increased age and female gender. These same regions are areas of poor bone in where implant fixation is required. This study suggests that surgeons placing screws within these periacetabular zones should expect poor fixation with increased age and female gender, therefore, additional fixation devices or methods may be required.

The linear morphometry and volume measurement inform on the normal pelvic morphometry for comparison on implant sizing and operative planning. Variability provides guidance on size and implant details including in more complex revision cases with poor bone stock. It provides reassurance that adult pelvic measurements remain constant over a decade and that they are likely to remain constant throughout adulthood. In addition to the linear and volume measurements, the mean density measurements can provide valuable information for finite element analysis and modeling of loads within the pelvis.

Investigation into density changes in the pelvis has been undertaken by Telfer and colleagues who looked at 60 innominate pelvic bones and relationship between cortical bone and age and gender [32]. The results of this study are in keeping with this work also elucidating cortical‐based changes significant for gender and age above the level of acetabulum, however, their study was population based and not longitudinal. The natural changes noted within the pelvis in this study are in contrast to the findings of a previous meta‐analysis post‐total hip replacement [6]. The meta‐analysis reported post‐total hip replacement reductions in cortical density proximally and in cancellous density in younger patients. The difference in density of the periacetabular bone between the present study and previous meta‐analysis supports the theory of stress shielding. The different changes within the native pelvis are evidence of a different loading pattern with normal gait pattern and may be attributable the high Young's modulus of the acetabular implant or the change in joint reactions forces creating stress shielding [33, 34]. To the best of the authors' knowledge, there are no studies of native longitudinal acetabular density assessed using dual‐emission X‐ray absorptiometry (DEXA). However, DEXA studies post‐joint replacement measure combined cortical and cancellous density and have demonstrated an initial reduction of periacetabular BMD at the level of the implant which had slowed or improved by early follow‐up [35, 36, 37].

The findings of increased cortical density and reduced volume with aging in our study were notable and an area of future research will involve assessing the microarchitecture of pelvic bones to relate these density changes to structural property. Notably, Zebaze and colleagues demonstrated that increased cortical porosity with age can account for measured loss of cortical bone volume [38, 39]. Their work concluded that trabecularization of the cortex obscures true age‐related trabecular bone loss. It is likely that the thresholding segmentation used for this study is susceptible to demonstrating reduced cortical volume in the presence of cortical porosity. In addition to this limitation, there are further limitations of our work. First, this was a retrospective opportunistic analysis of scans taken for clinical reasons and patients are likely to have underlying health conditions to undergo repeat CT scans 10 years apart. The baseline health and treatment of the patients included is not known and individual factors such as osteoporosis and the use of antiresorptive medications may have influenced our results. Second, the orientation of the scan is set by the axial slices derived by the radiology department. However, each side is recentred on the femoral head and the first level of the acetabulum as such there would be minimal error even in the presence of significant obliquity or tilt due to the short distance from the calibrating landmark at the femoral head and acetabulum. Third, the mean age of the patients at baseline was 54 years which results in a younger cohort than the geriatric age group in which acetabular fractures and arthroplasty are most common. Finally, the authors acknowledge that whilst an individual anatomical calibration occurred for each CT scan, the imaging capture protocols may have influenced our findings due to different scan settings, type of scanner used, and scanner drift over time.

5. Conclusion

This is the first longitudinal CT study of bone density and volume in the periacetabular region of the native pelvis. This study demonstrated that the overall volume of the pelvic bone remains constant with age, but the amount of cortical bone is reduced whilst the cancellous volume increases. Conversely, the density of cancellous bone is reduced whilst cortical bone density increases over time. This results in a periacetabular region that has decreased cancellous bone density covered by a sclerotic thinner cortical wall. The changes described with aging explain known geriatric acetabular fracture patterns and the difficulty in fixing these fractures and achieving press fit acetabular cup fixation in older patients.

Ethics Statement

Ethical approval was sought from the local hospital network ethics board, the CALHN Human Research Ethics Committee (CALHN HREC Approval 20169).

Acknowledgments

Open access publishing facilitated by Adelaide University, as part of the Wiley – Adelaide University agreement via the Council of Australasian University Librarians.

Robertson T., Dong X., Abrahams J., Solomon B., Nelissen R., and Callary S., “Longitudinal Density and Volume Changes of Periacetabular Cancellous and Cortical Bone,” Journal of Orthopaedic Research (2026. 44:): e70167, 10.1002/jor.70167.

Thomas Robertson and Xiangyu Dong are joint first authors.

References

  • 1. Maier G. S., Kolbow K., Lazovic D., and Maus U., “The Importance of Bone Mineral Density in Hip Arthroplasty: Results of a Survey Asking Orthopaedic Surgeons About Their Opinions and Attitudes Concerning Osteoporosis and Hip Arthroplasty,” Advances in Orthopedics 2016 (2016): 8079354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Tabata T., Kaku N., Hara K., and Tsumura H., “Initial Stability of Cementless Acetabular Cups: Press‐Fit and Screw Fixation Interaction—An In Vitro Biomechanical Study,” European Journal of Orthopaedic Surgery & Traumatology 25 (2015): 497–502. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. Schmidt R., Kress A. M., Nowak M., Forst R., Nowak T. E., and Mueller L. A., “Periacetabular Cortical and Cancellous Bone Mineral Density Loss After Press‐Fit Cup Fixation,” Journal of Arthroplasty 27 (2012): 1358–1363.e1. [DOI] [PubMed] [Google Scholar]
  • 4. Mueller L. A., Voelk M., Kress A., Pitto R. P., and Schmidt R., “An ABJS Best Paper: Progressive Cancellous and Cortical Bone Remodeling After Press‐Fit Cup Fixation: A 3‐Year Follow‐Up,” Clinical Orthopaedics & Related Research 463 (2007): 213–220. [PubMed] [Google Scholar]
  • 5. Speirs A. D., Beaulé P. E., Rakhra K. S., Schweitzer M. E., and Frei H., “Increased Acetabular Subchondral Bone Density Is Associated With Cam‐Type Femoroacetabular Impingement,” Osteoarthritis and Cartilage 21 (2013): 551–558. [DOI] [PubMed] [Google Scholar]
  • 6. Robertson T. S., Pijls B. G., Munn Z., Solomon L. B., Nelissen R. G. H. H., and Callary S. A., “Change in CT‐Measured Acetabular Bone Density Following Total Hip Arthroplasty: A Systematic Review and Meta‐Analysis,” Acta Orthopaedica 94 (2023): 191–199. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. Solomon L. B., Howie D. W., and Henneberg M., “The Variability of the Volume of Os Coxae and Linear Pelvic Morphometry. Considerations for Total Hip Arthroplasty,” Journal of Arthroplasty 29 (2014): 769–776. [DOI] [PubMed] [Google Scholar]
  • 8. Hettich G., Schierjott R. A., Ramm H., et al., “Method for Quantitative Assessment of Acetabular Bone Defects,” Journal of Orthopaedic Research 37 (2019): 181–189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Stamenkov R. B., Howie D. W., Neale S. D., McGee M. A., Taylor D. J., and Findlay D. M., “Distribution of Periacetabular Osteolytic Lesions Varies According to Component Design,” Journal of Arthroplasty 25 (2010): 913–919. [DOI] [PubMed] [Google Scholar]
  • 10. Stamenkov R., Howie D., Taylor J., et al., “Measurement of Bone Defects Adjacent to Acetabular Components of Hip Replacement,” Clinical Orthopaedics & Related Research 412 (2003): 117–124. [DOI] [PubMed] [Google Scholar]
  • 11. Howie D. W., Neale S. D., Stamenkov R., McGee M. A., Taylor D. J., and Findlay D. M., “Progression of Acetabular Periprosthetic Osteolytic Lesions Measured With Computed Tomography,” Journal of Bone & Joint Surgery 89 (2007): 1818–1825. [DOI] [PubMed] [Google Scholar]
  • 12. Howie D. W., Neale S. D., Martin W., et al., “Progression of Periacetabular Osteolytic Lesions,” Journal of Bone and Joint Surgery 94 (2012): e117. [DOI] [PubMed] [Google Scholar]
  • 13. Boskey A. L. and Imbert L., “Bone Quality Changes Associated With Aging and Disease: A Review,” Annals of the New York Academy of Sciences 1410 (2017): 93–106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14. Yang H., Albiol L., Chan W. L., et al., “Examining Tissue Composition, Whole‐Bone Morphology and Mechanical Behavior of Gorab(Prx1) Mice Tibiae: A Mouse Model of Premature Aging,” Journal of Biomechanics 65 (2017): 145–153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Boskey A. L. and Coleman R., “Aging and Bone,” Journal of Dental Research 89 (2010): 1333–1348. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16. Miller P. D., “Management of Severe Osteoporosis,” Expert Opinion on Pharmacotherapy 17 (2016): 473–488. [DOI] [PubMed] [Google Scholar]
  • 17. Thomas C. D. L., Mayhew P. M., Power J., et al., “Femoral Neck Trabecular Bone: Loss With Aging and Role in Preventing Fracture,” Journal of Bone and Mineral Research 24 (2009): 1808–1818. [DOI] [PubMed] [Google Scholar]
  • 18. Gori F., Lerner U., Ohlsson C., and Baron R., “A new WNT on the Bone: WNT16, Cortical Bone Thickness, Porosity and Fractures,” BoneKEy Reports 4 (2015): 669. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Holzer G., von Skrbensky G., Holzer L. A., and Pichl W., “Hip Fractures and the Contribution of Cortical Versus Trabecular Bone to Femoral Neck Strength,” Journal of Bone and Mineral Research 24 (2009): 468–474. [DOI] [PubMed] [Google Scholar]
  • 20. Johannesdottir F., Poole K. E. S., Reeve J., et al., “Distribution of Cortical Bone in the Femoral Neck and Hip Fracture: A Prospective Case‐Control Analysis of 143 Incident Hip Fractures; the AGES‐REYKJAVIK Study,” Bone 48 (2011): 1268–1276. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Manske S. L., Liu‐Ambrose T., Cooper D. M. L., et al., “Cortical and Trabecular Bone in the Femoral Neck Both Contribute to Proximal Femur Failure Load Prediction,” Osteoporosis International 20 (2009): 445–453. [DOI] [PubMed] [Google Scholar]
  • 22. Frost H. M., “Wolff's Law and Bone's Structural Adaptations to Mechanical Usage: An Overview for Clinicians,” Angle Orthodontist 64 (1994): 175–188. [DOI] [PubMed] [Google Scholar]
  • 23. Rinne P. P., Laitinen M. K., Huttunen T., Kannus P., and Mattila V. M., “The Incidence and Trauma Mechanisms of Acetabular Fractures: A Nationwide Study in Finland Between 1997 and 2014,” Injury 48 (2017): 2157–2161. [DOI] [PubMed] [Google Scholar]
  • 24. Khalifa A. A., Mahran D. G., Fergany A., and Farouk O., “Epidemiology of Acetabular Fractures in Elderly Patients and the Effect of Various Management Options on the Outcomes. A Comprehensive Narrative Review,” International Journal of Orthopaedic and Trauma Nursing 53 (2024): 101049. [DOI] [PubMed] [Google Scholar]
  • 25. Ljungdahl J., Hernefalk B., Pallin A., Bruggemann A., Hailer N. P., and Wolf O., “Mortality and Reoperations Following Treatment of Acetabular Fractures in Patients ≥ 70 Years: A Retrospective Cohort Study of 247 Patients,” Acta Orthopaedica 96 (2025): 94–101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Albrektsson M., Möller M., Wolf O., Wennergren D., and Sundfeldt M., “Acetabular Fractures: Epidemiology and Mortality Based on 2,132 Fractures From the Swedish Fracture Register,” Bone & Joint Open 4 (2023): 652–658. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27. Ritter D., Denard P. J., Raiss P., Wijdicks C. A., and Bachmaier S., “Preoperative 3‐Dimensional Computed Tomography Bone Density Measures Provide Objective Bone Quality Classifications for Stemless Anatomic Total Shoulder Arthroplasty,” Journal of Shoulder and Elbow Surgery 33 (2024): 1503–1511. [DOI] [PubMed] [Google Scholar]
  • 28. Eggermont F., Verdonschot N., van der Linden Y., and Tanck E., “Calibration With or Without Phantom for Fracture Risk Prediction in Cancer Patients With Femoral Bone Metastases Using CT‐Based Finite Element Models,” PLoS One 14 (2019): e0220564. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29. Ghosh R., Pal B., Ghosh D., and Gupta S., “Finite Element Analysis of a Hemi‐Pelvis: The Effect of Inclusion of Cartilage Layer on Acetabular Stresses and Strain,” Computer Methods in Biomechanics and Biomedical Engineering 18 (2015): 697–710. [DOI] [PubMed] [Google Scholar]
  • 30. Ferguson T. A., Patel R., Bhandari M., and Matta J. M., “Fractures of the Acetabulum in Patients Aged 60 Years and Older: An Epidemiological and Radiological Study,” Journal of Bone and Joint Surgery. British Volume 92 (2010): 250–257. [DOI] [PubMed] [Google Scholar]
  • 31. Firoozabadi R., Cross W. W., Krieg J. C., and Routt M. L. C., “Acetabular Fractures in the Senior Population‐ Epidemiology, Mortality and Treatments,” Archives of Bone and Joint Surgery 5 (2017): 96–102. [PMC free article] [PubMed] [Google Scholar]
  • 32. Telfer S., Brunnquell C. L., Allen J. D., Linnau K. F., Zamora D., and Kleweno C. P., “The Effect of Age and Sex on Pelvic Bone Density Measured Opportunistically in Clinical CT Scans,” Journal of Orthopaedic Research 39 (2021): 485–492. [DOI] [PubMed] [Google Scholar]
  • 33. Manley M. T., Ong K. L., and Kurtz S. M., “The Potential for Bone Loss in Acetabular Structures Following THA,” Clinical Orthopaedics & Related Research 453 (2006): 246–253. [DOI] [PubMed] [Google Scholar]
  • 34. Dickinson A. S., Taylor A. C., and Browne M., “The Influence of Acetabular Cup Material on Pelvis Cortex Surface Strains, Measured Using Digital Image Correlation,” Journal of Biomechanics 45 (2012): 719–723. [DOI] [PubMed] [Google Scholar]
  • 35. Smolders J. M. H., Pakvis D. F., Hendrickx B. W., Verdonschot N., and van Susante J. L. C., “Periacetabular Bone Mineral Density Changes After Resurfacing Hip Arthroplasty Versus Conventional Total Hip Arthroplasty. A Randomized Controlled Dexa Study,” Journal of Arthroplasty 28 (2013): 1177–1184. [DOI] [PubMed] [Google Scholar]
  • 36. Field R. E., Cronin M. D., Singh P. J., Burtenshaw C., and Rushton N., “Bone Remodeling Around the Cambridge Cup: A DEXA Study of 50 Hips Over 2 Years,” Acta Orthopaedica 77 (2006): 726–732. [DOI] [PubMed] [Google Scholar]
  • 37. Laursen M. B., Nielsen P. T., and Søballe K., “Bone Remodelling Around HA‐Coated Acetabular Cups: A DEXA Study With a 3‐Year Follow‐Up in a Randomised Trial,” International Orthopaedics 31 (2007): 199–204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38. Zebaze R. M., Ghasem‐Zadeh A., Bohte A., et al., “Intracortical Remodelling and Porosity in the Distal Radius and Post‐Mortem Femurs of Women: A Cross‐Sectional Study,” Lancet 375 (2010): 1729–1736. [DOI] [PubMed] [Google Scholar]
  • 39. Zebaze R., Atkinson E. J., Peng Y., et al., “Increased Cortical Porosity and Reduced Trabecular Density Are Not Necessarily Synonymous With Bone Loss and Microstructural Deterioration,” JBMR Plus 3 (2019): e10078. [DOI] [PMC free article] [PubMed] [Google Scholar]

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