CT-based age-related trabecular redistribution in the proximal femur and its association with fracture patterns in elderly individuals with and without diabetes.
Chen S, Ma X, et al. • Frontiers in endocrinology • 2026
Although bone density in the proximal femur generally declines with age, trabecular redistribution occurs characterized by a relative reduction in tension trabeculae and a relatively stable ratio of compression trabeculae, but in elderly diabetic patients with fractures, the compression trabeculae fail to maintain this stable ratio, which may reflect altered trabecular adaptation associated with fracture susceptibility.
Key Findings
Results
CT values in all six regions of the proximal femur decreased significantly with increasing age.
Six regions measured: primary compression trabecula, overlapping area, primary tension trabecula, secondary compression trabecula, greater trochanter, and lateral of primary tension trabecula.
The decrease in CT values across all six regions was statistically significant (p<0.01).
CT-based measurement of bone density was used as the primary quantitative tool via retrospective analysis of hip computed tomography images.
The study included elderly individuals across multiple age groups to capture age-related trends.
Results
The ratio of primary compression trabecular area to the overlapping area remained relatively stable with age.
Statistical analysis showed F = 1.84, p = 0.12, indicating no significant change in this ratio with increasing age.
This finding suggests that compression trabeculae are preferentially preserved relative to the overlapping region as individuals age.
The overlapping area refers to the region where compression and tension trabeculae intersect in the proximal femur.
Results
The ratio of primary tension trabecular area to the overlapping area decreased significantly with age.
Statistical analysis showed F = 9.67, p < 0.01, indicating a significant age-related decline in this ratio.
This finding indicates a relative reduction in tension trabeculae compared to the overlapping area as people age.
The contrast with the stable compression trabecula ratio suggests a differential pattern of age-related trabecular redistribution.
Results
Elderly patients with proximal femoral fractures exhibited significant trabecular redistribution compared to normal controls.
The study retrospectively analyzed hip CT images of elderly individuals with and without proximal femoral fractures.
Trabecular redistribution was characterized by measurable changes in CT values and regional ratios in fracture patients.
Both diabetic and non-diabetic elderly fracture patients were included for comparison.
Results
Elderly diabetic patients with femoral fractures showed a marked decrease in the ratio of primary compression trabecular area to the overlapping area compared to normal controls, unlike non-diabetic fracture patients.
The effect size for this comparison was d = -0.40, p < 0.05.
Non-diabetic elderly patients with proximal femoral fractures did not show this same significant decrease in the compression trabecula-to-overlapping area ratio.
This difference suggests that diabetes is associated with a failure of the normal compensatory preservation of compression trabeculae seen in aging.
This finding may help explain altered fracture susceptibility specifically in elderly diabetic patients.
Discussion
In elderly diabetic patients with fractures, compression trabeculae fail to maintain the stable ratio observed in normal aging, potentially reflecting altered trabecular adaptation.
Normal aging is associated with preserved compression trabecular ratios despite overall bone density decline.
Diabetic fracture patients deviate from this pattern, showing compression trabecular compromise.
The authors propose this may reflect altered trabecular adaptation associated with fracture susceptibility in diabetes.
These findings were interpreted as potentially improving understanding of why diabetic elderly individuals may be at different fracture risk than non-diabetic elderly individuals.
What This Means
This research suggests that as people age, the internal scaffolding structure of the hip bone (called trabeculae) does not simply weaken uniformly — instead, it undergoes a process called redistribution. Using CT scans, the researchers measured bone density in six specific areas of the upper femur (thigh bone near the hip) in elderly individuals. They found that while overall bone density declined with age across all regions, the struts that resist compression forces (compression trabeculae) maintained a relatively stable proportion compared to the overlapping central zone, whereas the struts that resist tension or pulling forces (tension trabeculae) became relatively reduced. This suggests the aging skeleton preferentially maintains load-bearing compression structures, which may be a natural adaptive response.
However, this research suggests that elderly people with diabetes who suffered hip fractures showed a distinctly different pattern: even their compression trabeculae failed to maintain the normally preserved ratio, setting them apart from non-diabetic elderly fracture patients. This breakdown in the usual compensatory mechanism may help explain why older adults with diabetes can be more vulnerable to certain types of hip fractures even when standard bone density measurements might not fully capture their risk.
The practical implication of this research is that standard bone density testing may not tell the whole story about fracture risk, particularly in elderly diabetic patients. Examining the specific regional distribution of trabecular bone using CT imaging — rather than just overall density — could potentially offer additional insight into who is most at risk for hip fractures. This could eventually inform more targeted monitoring or intervention strategies for high-risk elderly populations, particularly those living with diabetes.
Chen S, Ma X, Meng Q, Dong Y, Cheng Y, Gao L, et al.. (2026). CT-based age-related trabecular redistribution in the proximal femur and its association with fracture patterns in elderly individuals with and without diabetes.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1830903