Review June 2020

Fragility hip fracture, a serious manifestation of osteoporosis in the elderly, is a worldwide problem associated with low bone strength. With the increasing elderly population, incidence of hip fracture is estimated to be increased especially in Asian countries (1). Low bone mass has been recognised as the strongest risk factor for fragility fracture. However, studies have reported the limitations of assessing bone strength or fracture risk based on bone mass measurements alone (2, 3). The ability of a bone to resist fracture, or whole bone strength, depends not only on the bone mass, but also on bone size, shape, spatial distribution of bone mass, bone geometry, cortical and trabecular microarchitecture and the balance between bone formation and bone resorption (4). Therefore, the study of factors associated with geometric adaptations and biomechanical behaviours of the hip, as a compensatory mechanism for enhancing bone strength against low bone mass and hip fracture risk is important.