VOLUME 6 - NUMBER 1 - 2026

Local osteo-enhancement of the proximal femur in osteoporosis: biomechanical rationale and current evidence

  • Giovanni Guarascio, Stefano Gumina, Francesco Falez
  • Concise reviews, 33-35
  • Full text PDF

  • Fragility fractures are a major clinical consequence of osteoporosis and are associated with considerable morbidity and mortality. Hip fractures in particular remain among the most severe complications of skeletal fragility. Although bone mineral density (BMD) is widely used to assess fracture risk, bone strength is also influenced by structural and material properties collectively referred to as bone quality. Age-related deterioration of trabecular architecture in the proximal femur may contribute to localized mechanical weakness and increased fracture susceptibility.

    In this context, site-specific bone reinforcement strategies using resorbable biomaterials have been proposed to improve the mechanical competence of osteoporotic bone. Among these, the Local Osteo-Enhancement Procedure (LOEP) is a minimally invasive technique designed to reinforce structurally vulnerable regions of the proximal femur through targeted injection of a resorbable calcium-based biomaterial. This review analyzes the biomechanical rationale and the currently available evidence supporting LOEP. Preclinical studies suggest that injectable biomaterials may increase load-to-failure and energy absorption in osteoporotic bone models. Early clinical studies have reported increases in femoral neck BMD and estimated mechanical strength following LOEP. However, current clinical evidence remains limited and is largely based on surrogate endpoints rather than fracture reduction.

  • KEY WORDS: Osteoporosis, bone fragility, proximal femur, local osteo-enhancement, biomaterials.