Effects of Sex and Anatomical Location on Muscle and Adipose Thickness Surrounding the Proximal Femur: Implications for Fall-Related Impact Dynamics

Trochanteric soft tissues have significant effects on fall-related hip fracture risk; however, little is known about their composition and spatial distribution. Accordingly, this study determined (1) the influence of sex and anatomical location on muscle thickness, adipose thickness, and total soft tissue thickness surrounding the proximal femur; and (2) the effects of sex- and location-specific soft tissue thickness on predicted fall-related hip impact forces. Ultrasound was used to measure muscle thickness, adipose thickness, and total soft tissue thickness at 12 locations surrounding the proximal femur in 25 young adult participants. Fall-related hip impact forces were predicted with a mass-spring model, accounting for force attenuation by soft tissues, at 2 common impact sites. The data demonstrated that tissue thickness and impact forces were significantly influenced by sex and anatomical location. Males had more muscle, less adipose, less total soft tissues, less force attenuation, and higher impact forces than females. Total soft tissue thickness and muscle thickness were lowest over the lateral femur, while adipose thickness was lowest over the anterolateral femur. Force attenuation was higher while impact forces were lower at the posterolateral impact site. The data support that the accuracy of hip impact models could be improved by incorporating sex-, location-, and composition-specific soft tissue thickness measures.