Bone strength parameters of the femoral shaft and the influence of age, BMI and vBMD: Implications for forensic fracture evaluation.

Multiple interconnected parameters contribute to bone strength. The assessment of bone strength and fragility, which are crucial measures of bone health, is essential not only in the clinical setting for diagnosis but also in forensic medicine, where it aids in identifying the underlying cause of various bone traumas. This study aimed to examine the correlation between the bone strength parameters cortical thickness index (CTI), cortical bone thickness (CBT), endocortical area (ECA), and endocortical volume (ECV), and age, body mass index (BMI), and volumetric bone mineral density (vBMD) in a female autopsy-population. Measurements were performed on the left femur and derived from 103 post-mortem computed tomography (PMCT) images of females aged 24-95 years. Linear regression analysis showed a significant correlation between age and all the bone parameters, except for ECA. When BMI was accounted for, there was still a significant correlation between age and CTI, vBMD, CBT, and ECV. Individuals in the underweight and normal weight categories demonstrated lower CTI and CBT values than those classified as obese. A significant correlation was observed between vBMD and the four bone parameters CTI, CBT, ECV and ECA. This study highlights the importance of considering various bone strength parameters and their relationship with age, BMI, and vBMD in assessing bone strength.