Femoral neck osteoporosis occurs where the top of the thigh bone becomes weak and brittle from a loss of bone density.

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Like osteoporosis in other parts of the body, people with femoral neck osteoporosis tend not to have symptoms until they experience a break or fracture.

The condition affects 5% of people in the United States. It is more common in females and older adults, and various factors can increase a person’s risk of the condition. These include aging, low hormone levels, and calcium and vitamin D deficiencies.

People can treat the condition with medication and prevent future bone loss with lifestyle adjustments such as diet and exercise.

Read more to learn about the causes of femoral neck osteoporosis, treatment options, and more.

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The femur is the thigh bone. It consists of the femoral shaft, which runs from the hip to the knee, and the femoral head, which connects to the hip bone. The femoral neck is the part of the bone that connects the head with the shaft. The location of the femoral neck makes it prone to fractures.

Osteopenia refers to low bone density that falls below the typical, healthy range, but it is not low enough to fall into the osteoporosis category. The bone density of osteopenia ranges between -1 to -2.4, while the bone density of osteoporosis is any value lower than -2.5.

When the neck of the femur has low bone density, doctors call it femoral neck osteoporosis or osteopenia, depending on the severity. These conditions reduce the strength of the neck, which can cause it to fracture easily.

Osteoporosis is a silent disease, meaning a person usually does not have symptoms and may not know they have the condition until they have a fracture.

According to the Centers for Disease Control and Prevention (CDC), the prevalence of osteoporosis at the femoral neck is 5%. The prevalence of osteopenia at the site is 39%.

Additionally, the prevalence is higher in females and increases with age in all adults.

The following factors generally increase a person’s risk of osteoporosis. These are beyond someone’s ability to change.

  • Sex: Females have a higher risk of osteoporosis, but the condition may also affect males, particularly those older than 70 years.
  • Age: As people age, they lose bone more quickly and new bone growth occurs more slowly.
  • Race: Asian and white females have a higher risk, but African American females have a lower risk.
  • Body size: Thin-boned individuals have a higher likelihood of the condition because they have less bone mass to lose than those with larger bones.
  • Family history: Scientists find that if a person’s parent had a hip fracture, they have a higher risk of osteoporosis and fractures.

Below are causes and risk factors that may decline through either medical intervention or lifestyle changes:

  • Low hormone levels: This includes low estrogen levels in females and low testosterone levels in males.
  • Certain medical conditions: These include:
    • gastrointestinal disease, disorders affecting any part of the digestive system
    • some cancers
    • anorexia nervosa, an eating disorder that involves low body weight
    • HIV
    • rheumatoid arthritis, a form of arthritis that is an autoimmune disorder
    • other endocrine or hormonal conditions
  • Dietary factors: These include a diet low in these constituents:
    • calcium
    • protein
    • vitamin D
  • Long-term use of certain medications: Drugs with this effect include:
    • breast and prostate cancer drugs that involve aromatase inhibitors, such as anastrozole (Arimidex).
    • antiepileptic drugs for seizures, such as phenytoin (Dilantin)
    • glucocorticoids and adrenocorticotropic hormone for asthma or rheumatoid arthritis, such as prednisone (Deltasone)
    • selective serotonin reuptake inhibitors for depression or anxiety, such as sertraline (Zoloft)
    • proton pump inhibitors to lower stomach acidity, such as Omeprazole (Prilosec)
    • thiazolidinediones for diabetes, such as Rosiglitazone (Avandia)
  • Lifestyle factors: This refers to certain lifestyle practices that may lead to health issues, such as:
    • smoking
    • heavy drinking
    • low levels of physical activity

The danger of femoral neck osteoporosis involves a femoral neck fracture. When this occurs, it is a serious event that carries a risk of death and illness.

Treatment and prevention may include some of the below medications and nondrug interventions.

Medications

Some drugs that the Food and Drug Administration (FDA) has approved for osteoporosis include:

  • Bisphosphonates: These slow down bone loss to prevent fractures. An example is risedronate (Actonel).
  • Calcitonin (Calcimar): Manufacturers use recombinant DNA technology or synthesized chemical proteins to make this drug. It is an option for postmenopausal females who cannot tolerate other medications.
  • Estrogen agonist and antagonist: These drugs have effects similar to estrogen in some tissues and block the effects of estrogen in other tissues. An example is tamoxifen (Nolvadex).
  • Estrogen and hormone therapy: These include estrogen alone or a combination of estrogen and progestin, a synthetic form of the female hormone progesterone. Because of the side effects, people should weigh the risks against the benefits. An example of the combination is Climara Pro.
  • Parathyroid hormone (PTH) analog and parathyroid hormone-related protein analog (PTHrP): These increase bone mass. PTH is for postmenopausal females with osteoporosis who have a high likelihood of fractures. PTHrP is for postmenopausal females who have had fractures. An example of PTH is teriparatide (Forteo), while an example of PTHrP is abaloparatide (Tymlos).

Nondrug treatment

Doctors may suggest the following to slow bone loss and prevent fractures.

Exercise

Strength and resistance training can increase bone mass until a person reaches older age. Although exercise will not provide this benefit in older adults, it will:

  • increase muscle mass
  • improve balance
  • delay loss of independence

Research in 2018 evaluated the bone-strengthening effect of different exercises on the femoral neck. It found that fast walking or running may maintain or increase bone mineral density.

Nutrition

Doctors recommend a nutritious diet that includes:

  • lots of fruits and vegetables
  • foods containing:
    • calcium
    • protein
    • vitamin D
  • appropriate calories to maintain a moderate weight

Healthy lifestyle

A healthy lifestyle includes:

  • limiting alcohol to one drink per day for females and two drinks per day for males
  • quitting smoking and avoiding secondhand smoke
  • visiting a doctor for regular checkups and asking how to reduce the risk of falling

The concern relating to femoral neck osteoporosis is the likelihood of a fracture. A 2021 research article reports that if a person has a femoral neck fracture, they have a 6% in-house mortality rate, which is the risk of dying at home, as opposed to the hospital. Additionally, they have a 20–30% mortality rate within 1 year, with the highest risk falling within the first 6 months.

Femoral neck osteoporosis puts people at risk for a femoral neck fracture, a very serious event. Because of this risk, they may wish to engage in as many preventive practices as possible to slow bone loss and reduce this likelihood.

Prevention involves exercising regularly, eating a nutritious diet, and following a healthy lifestyle that includes quitting smoking and limiting alcohol intake to minimal or moderate amounts. It may also involve taking one of the medications that doctors prescribe for osteoporosis.