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. 2019 Jul 16;9:10305. doi: 10.1038/s41598-019-46739-y

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Graphical abstract of the project: Thirty-two paired femora (a) underwent QCT scanning (b) and elastic biomechanical experiments to determine stiffness (c). Based on clinical distribution in patients who suffered a pathologic fracture (d), metastatic lesions were simulated in either the superolateral or inferomedial neck in one femur of each pair (e), followed by a second QCT scan and stiffness test. All femora were then subjected to an ultimate biomechanical test to determine failure load¹¹ (f). A FE model was generated based on geometry and bone density distribution (BV/TV) retrieved from QCT images (g). Experimental data were used to evaluate the QCT-based FE model (h).