title: Bone microarchitecture of the talus changes with aging.
abstract: BACKGROUND
  Fractures of the talus in the elderly are rare and usually result from high-impact injuries, suggesting only minor age-related bone structure changes. However, total ankle replacement failures with age often result from talar subsidence, suggesting age-related bone loss in the talus. Despite a number of histological analyses of talar microarchitecture, the effects of age and sex on talar microarchitecture changes remain poorly defined.
  
  
  OBJECTIVE
  The aim of this study was to analyze changes or differences in the trabecular microarchitecture of the talus with regard to (1) age and (2) sex.
  
  
  METHODS
  Sixty human tali were harvested from 30 patients at autopsy of three different age groups (20-40, 41-60, 61-80 years). The specimens were analyzed by radiography, micro-CT, and histological analysis. Given that there was no difference between the left and right talus, static histomorphometric parameters were assessed in three regions of interest of the right talus only (body, neck, head; n = 30).
  
  
  RESULTS
  The talar body, neck, and head were affected differently by age-related changes. The greatest loss of bone volume with age was seen in the talar body (estimate: -0.239; 95% confidence interval [CI], -0.365 to -0.114; p < 0.001). In the talar neck (estimate: -0.165; 95% CI, -0.307 to -0.023; p = 0.025), bone loss was only moderate and primarily was the result of reduction in trabecular thickness (estimate: -1.288; 95% CI, -2.449 to -0.127; p = 0.031) instead of number (estimate: -0.001; 95% CI, -0.005 to -0.003; p = 0.593). Bone structure changes were independent of sex.
  
  
  CONCLUSIONS
  Age-related bone structure changes predominantly occur in the talar body, which poses a potential risk factor for total ankle replacement loosening. The moderate changes in the talar neck might explain the persistent low incidence of talar neck fractures with age.
  
  
  CONCLUSIONS
  Our findings suggest that before total ankle replacement implantation, careful patient selection with dual-energy xray absorptiometry evaluation may be necessary to reduce the risk of talar implant subsidence.
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 52, 22529, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Krause
authors.forename: Martin
authors.initials: M
authors.lastname: Rupprecht
authors.forename: Marcus
authors.initials: M
authors.lastname: Mumme
authors.forename: Klaus
authors.initials: K
authors.lastname: Püschel
authors.forename: Michael
authors.initials: M
authors.lastname: Amling
authors.forename: Florian
authors.initials: F
authors.lastname: Barvencik
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001344:Autopsy; D016723:Bone Remodeling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000473:pathology*; D012737:Sex Factors; D013628:Talus / Q000000981:diagnostic imaging / Q000473:pathology*; D055114:X-Ray Microtomography; D055815:Young Adult
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