Table of Contents
Clients often ask me three questions about the femoral neck: where is this bone located? what does my DEXA report say about it? and what can I do to reduce the risk of a fracture of the femoral neck? This post answers those questions. It also covers great hip strength exercises, along with balance exercises, that will help you reduce your risk of fracturing the femoral neck of your hip.
If you have just had a bone density scan and the femoral neck score is the number that worries you, you are in the right place.
What is the Femoral Neck?
The femoral neck is the part of the femur that is measured when you have a bone mineral density test (DEXA). This portion of your femur bone is measured because it has a larger percentage of soft bone than the rest of your femur. This makes it more vulnerable to a fracture.
Hip fractures are a serious concern, not just for the person who has one but for the strain they place on health systems. Hip fracture is the most common reason for emergency anaesthesia and surgery in older people, and in the UK it accounts for around half a million hospital bed days each year. (12) Around 26 percent of people die within twelve months of a hip fracture, and of those who survive, only about half are living in their own home 120 days later. (12) Falling on your hip is a common cause of a hip fracture, which is why improving your balance matters as much as strengthening the muscles around your hips.
Where is the Femoral Neck?
The femur is the leg bone (the thigh bone) connecting the knee joint to the pelvis.
At the top of the femur is a thin piece or strip of bone that connects the long shaft of the thigh bone to the head of the femur. That thin strip of bone is femoral neck. The head of the femur is semi-dome shaped bone that rests in the hip.
What Does "Left Femoral Neck" Mean on Your Bone Density Report?
Your DEXA reports the results from scanning the femoral neck. The row could labelled “Left Femoral Neck”, “Right Femoral Neck”, or “Dual Femur Neck”.
Those labels are not describing three different problems. They are telling you which hip (or hips) the technologist measured.
Why Your Report Shows One Hip, Both, or “Dual Femur”
Most reports show one hip. The majority of DEXA reports I reviewed include only the left femoral neck score. Some show both. Which you get depends on the machine, the protocol at that centre, and sometimes on what your insurance covers.
When researchers measured both hips in 1,505 people, about one in four ended up in a different diagnostic category depending on which hip was looked at, and one in ten would have been given a different treatment recommendation. (1) Across three earlier studies, between 5 and 9 percent of people had osteoporosis in one hip when the other hip and the spine did not. (2, 3, 4)
The stated rationale for reporting both hips is that it gives a better estimate of your fracture risk, because it captures your lowest reading. (5)
So if you have low bone density, are over about 68, have a parent who fractured a hip, or take steroid medication, it is reasonable to ask whether both of your hips were scanned. (1)
Why Your Left and Right Femoral Neck Scores Don’t Match
If your report shows both hips, do not be surprised when the two numbers differ.
In one study of 384 postmenopausal women, about 30 percent had a meaningful difference between their two hips. (6) In another, 44 percent had inconsistent results between sides, and the lower scores tended to show up in the dominant leg. (7)
When I discussed similar results I found with my patients with researchers at a bone research conference a few years back, we hypothesized that since we lead with the dominant leg, the non-dominant leg gets more of the weight bearing such as when kicking a ball.
When you compare a new scan to an old one, compare the same side. Left to left, right to right. Otherwise you are not measuring change, you are measuring the difference between your hips.
What Does Femoral Neck BMD Mean on Your Report?
Your report gives you two different kinds of number, and they are easy to confuse.
BMD is your bone mineral density, written in grams per square centimetre, something like 0.927 g/cm2. It is the raw measurement. On its own it tells you very little, because there is no way to know from the number alone whether it is good or poor for someone your age.
Your T-score and Z-score are that raw number translated into something comparable. Reports usually give BMD to three decimal places and the scores to one decimal place, so a line reading 0.927 and -2.3 is formatted exactly as it should be. (8)
Understanding Your Femoral Neck T-Score and Z-Score
Your T-score compares your bone density to that of a healthy young adult. It is the number used to make a diagnosis. The chart below covers the femoral neck T-Score in more detail and what they mean.
Above -1.0 is considered normal. Between -1.0 and -2.5 is called low bone mass, or osteopenia. At -2.5 or lower, the diagnosis is osteoporosis. (8, 9)
Your Z-score compares you to people of your own age, sex and ethnicity. It is the more useful number if you are a premenopausal woman or a man under 50, and a low Z-score is a signal to look for an underlying cause rather than to assume ordinary age-related bone loss. (8)
What Almost Nobody Explains About Your Femoral Neck Score
Here are several things about your femoral neck reading that almost nobody explains.
- Ward’s area is not your diagnosis. If your report lists Ward’s area or the greater trochanter, you may find a much worse number sitting there. Those regions are not used for diagnosis. (8) It is the femoral neck and total hip that count.
- The femoral neck is the least precise of the three sites. The accepted precision for the femoral neck allows for about a 6.9 percent change before it counts as a real change, compared with roughly 5 percent at the total hip and the lumbar spine. (8) Which means a small drop between two scans may not be a drop at all.
What Your Report Should Not Say
ISCD publishes a list of things that do not belong in a bone density report. If you find one of these on yours, it is fair to ask about it. (8)
- That you have lost bone, when this is your first scan. A single scan shows your density today. It cannot show a change, because there is no earlier number to compare with.
- “Mild,” “moderate,” or “marked” osteopenia or osteoporosis. There are no such grades. There is normal, low bone mass, and osteoporosis.
- A separate diagnosis for each region, such as osteopenia at the hip and osteoporosis at the spine. You get one diagnosis, based on your lowest valid site.
- A comparison like “you have the bones of an 80-year-old,” if you are not 80. Your Z-score already tells you how you compare with people your own age.
- Results from a site that could not be measured properly.
Which Hip Goes Into FRAX?
FRAX, the fracture risk calculator, takes femoral neck bone density and only femoral neck bone density. Readings from other sites are not recommended as substitutes. (10)
What FRAX does not tell you is which femoral neck to use when you have two readings.
The guidelines are clear on the related questions. For diagnosis, the lowest T-score of the right or left femoral neck or total hip is used, never the average of the two sides. For tracking change over time, the mean of both total hips is preferred. (11) But for the FRAX input specifically, no position exists.
In practice, most clinicians will use the lower of the two, because the whole point of measuring both hips is to catch the lower reading, and the goal is not to under-treat.
Ask your physician: which hip did you enter for my FRAX assessment?
When the Femoral Neck Can’t Be Measured
Sometimes the row simply is not there, and that is not an error.
A hip with a replacement in it cannot be measured. The hardware makes the reading meaningless, so the other hip is used instead. Severe hip arthritis causes a subtler problem: getting a good measurement requires the leg to be turned out and rotated inward by about 15 to 20 degrees, (5) and an arthritic hip often will not go there comfortably.
If neither hip nor spine can be measured or interpreted, your forearm can be used instead. (8) And FRAX can be run without any bone density number at all, using your clinical risk factors alone, which is the route for someone who has had both hips replaced. (10)
What Does Femoral Neck Osteopenia Actually Mean?
For a great many of my clients, the femoral neck is the number that got them their diagnosis of osteopenia or osteoporosis. It is often the lowest reading on the whole report, and because a diagnosis is made on the lowest of the lumbar spine, the total hip or the femoral neck, that one row can be the reason for your diagnosis.
However, if your hip looks worse than your spine, that does not necessarily mean your hip is in worse shape. Spine readings in older adults are often pushed artificially high by ordinary wear and tear in the joints or compression fractures, which makes the spine a less reliable site with age. (12) The femoral neck is frequently the more trustworthy number, not the unluckier one. It is also why the femoral neck is the site the fracture risk calculators, such as the FRAX, were built around. (12)
Osteopenia, or Low Bone Mass
The word osteopenia is still used, though the bodies that write the definitions now prefer low bone mass, or low bone density. And they are explicit about what it does and does not mean: people with low bone mass or density are not necessarily at high fracture risk. (8)
Most people who receive this result assume the opposite.
To put some numbers around it: in the UK, about 21.8 percent of women and 6.8 percent of men over 50 have a femoral neck T-score of -2.5 or below. (12) Roughly one in five women over fifty. You are not an unusual case.
How Serious Is Osteoporosis of the Femoral Neck?
A low number is not a fracture. Bone density is one risk factor among several, and an important one, but it is not the whole picture. The guidelines are blunt about this: the majority of people who go on to break a bone have a femoral neck T-score above -2.5. (12) In a study of nearly 150,000 postmenopausal women, those with a T-score of -2.5 or below did have the highest fracture rates, but they accounted for only 18 percent of the osteoporotic fractures and 26 percent of the hip fractures. (5)
While a low score is not destiny, a normal score is not a clean bill of health either. What matters is your overall risk, and that takes in your age, your history, whether a parent broke a hip, what medications you take, and how likely you are to fall.
The useful way to think about a risk figure is in whole people rather than percentages. If your ten-year risk comes back at 23 percent, that means of 100 people like you, 23 will break a bone over the next ten years and 77 will not. (12) Both halves of that sentence are true and you are entitled to hear both.
What to Do Next
Discuss your results with your doctor. Be open to their perspective on your overall relative risk of a fracture. Listen to their recommendations. Pharmaceutical intervention might be the appropriate path coupled with an appropriate exercise program that both improves bone health and reduces fracture risk.
An appropriate osteoporosis exercise program designed by an experienced health professional is essential. Guidelines are unanimous that regular weight-bearing and strength training exercise, tailored to what you can actually do, belongs in the management of low bone density. (12) That is the part you control.
Stronger Bones Exercise Course
Stronger bones in just 7 days with my free email course. Each day you’ll receive a short lesson on how to build stronger bones. Start now.
Stronger bones in just 7 days with my free email course.
Why the Femoral Neck is Vulnerable
Why do we care about the femoral neck fractures? There are certain parts of our body that has more soft bone, or trabecular bone. The femoral neck is one such area. Throughout our body, we have cortical bone, very hard bone, and we have the soft spongy bone.
The long shaft of our femur has lots of cortical bone. It’s the type of bone (usually, the cross-section of the femur of a cow) that you would give your dog to chew on. Your dog will chew on it for weeks sometimes because it’s very strong cortical bone.
However, bone in the neck of femur also has a very high percentage of trabecular bone, soft spongy bone. Much like bone in each vertebrae of your spine, in your ribs, and in your skull.
These bones are at a higher risk of being fractured if you’re doing things that require or put it above and beyond what the bone strength is able to withstand.
With that behind us, let’s talk about how to increase femoral neck bone density. After that we can talk about is how to protect your neck of femur when you exercise.
Closed Kinetic Chain Exercise and the Femoral Neck
A recent very small study in the Journal of Physical Therapy Science (16) looked specifically at whether closed kinetic chain or open kinetic chain exercises helped the neck of femur and specifically increase femoral neck bone density. The study concluded that patients should practice closed kinetic chain exercises.
A closed kinetic chain exercise is an exercise where one of the supporting limbs is fixed in place. An example would be when you are doing an active exercise but keep standing and maintain contact with the floor. When you perform a squat, a lunge, or stepping and you have that foot contact to the ground, that is a closed kinetic chain exercise.
Sometimes you see an open kinetic chain exercise in the gym where there are pads to hook your feet under and you’re asked to lift the weight. In that exercise, there’s no ground contact with the base of your feet. That is an open kinetic chain exercise versus a squat where your feet are in contact with the floor and you’re pressing up tall.
In the study, the authors conclude “Osteoporotic postmenopausal women should be prescribed closed kinetic chain exercise to diminish the effects of the disease and minimize their risk of fall.” With that, let’s look at a closed kinetic chain femoral neck osteoporosis exercise you should make part of your regular exercise program.
Exercises to Increase Femoral Neck Bone Density
The evidence here is about as good as it gets in this field. Programmes that combine weight-bearing and resistance strengthening exercise are effective at reducing bone loss at the femoral neck and the lumbar spine in postmenopausal women, at the highest level of evidence the guidelines recognise. (12) And people with osteoporosis can take part in exercise safely: serious adverse events are very rare. (12)
What follows is what I give my own clients. Consistent weight-bearing activity, preferably with load involved.
Start Here: Side-Lying Leg Lifts
Before you begin any of the exercises below, consider the side-lying leg lift as your foundation. It builds strength in the gluteus medius, the gluteus minimus and the tensor fasciae latae, all of which you need in order to perform the weight-bearing exercises properly.
I often find that the people I work with, especially those over 50, have not built up adequate strength in these muscles. Skipping this step is the most common reason a squat or a lunge goes wrong.
The Six Exercises to Increase Bone Density in the Hips and Femoral Neck
Once you have mastered the side-lying leg lift, you can move on to these progressive exercises for the femoral neck
- Brisk walking
- Running
- Heel drops
- Squats, starting with a chair and progressing by adding load
- Lunges
- Jumps and squat jumps
One caution from the guidelines that is worth passing on: repetitive forced forward bending of the spine should be approached with care if you have osteoporosis, as that specific movement may carry an increased risk of new vertebral compression fractures. (12) It is not the femoral neck that is at issue there, but it is the kind of thing worth knowing before you start loading up.
Brisk Walking
Brisk walking has been shown to reduce the risk of hip fractures.
Running
Running is an excellent choice for weight bearing.
Heel Drops
You can do heel drops at home and when you are out for your daily walk.
Squats
Squats not only improve hip strength, they are very functional meaning you will use them regularly in daily life. You can easily progress to more advanced squats as you get stronger.
The Lunge Exercise
The lunge exercise allows you to increase bone health as well as practice your alignment.
Jump Exercise
The jump exercise is appropriate for individuals with a low risk of fracture.
Consistency Is the Part That Actually Matters
Here is the thing I most want you to take away, and it is not an exercise.
Consistency and sustainability are critical.
Two of my clients, quite independently of one another, set out to increase their hip bone density. Both chose the same approach: brisk walking on a treadmill each morning while wearing a weighted vest. Both increased their hip DEXA scores. And both, sadly, lost those gains after they stopped wearing the vest and reduced how often they walked.
I tell you that not to sell you a weighted vest. Two people is two people, and I would not build a recommendation on it. I tell you because of what happened at the end. Bone responds to the loading you give it, and it responds to the loading you stop giving it. The programme you will still be doing in three years is worth more than the ideal programme you abandon in three months.
So when you look at the list above, do not ask which exercise is best. Ask which of these you can see yourself still doing next winter and beyond.
Femoral Neck and Yoga
Now that you know how to increase femoral neck bone density through exercise, let’s discuss how to protect your neck of femur if you have osteoporosis.
For those of you who practice yoga, I highly recommend that you avoid doing the pigeon pose. In the pigeon pose, you put the neck of femur under considerable torque and then put the weight of your body on the femoral neck. This degree of stress could fracture a femoral neck with osteoporosis.
Instead, you can substitute the figure four. The figure four is in Exercise for Better Bones. It uses the same type of rotation as the figure four, however, in the Exercise for Better Bones version you are lying on your back and not loading your body over a fragile femoral neck.
Exercise intelligently and keep safe.
Stronger bones in just 7 days with my free email course.
Osteoporosis and Neck Pain
The neck of the femur has nothing to do with the neck on your shoulders, and yet the two get tangled together constantly. Sometimes that is simple confusion over the word. Sometimes it is the very real neck and shoulder tension that arrives with a frightening bone density result. To learn more, read my blog on osteoporosis neck pain.
I cover both, and give you two stretches, here:
Bisphosphonates and Atypical Femoral Fractures
If you take a bisphosphonate, you have probably heard something about unusual thigh bone fractures, and you may be wondering whether the femoral neck is the one at risk.
It is not. These fractures have a name now, atypical femoral fractures, and they happen in the shaft of the femur and just below the hip, well below the femoral neck. (13) They are also rare: the absolute risk sits somewhere between about 3 and 50 cases per 100,000 person-years of exposure. (12)
Compare that risk to the benefit that the medication is doing for you. The rate of atypical fracture after eight years of treatment has been put at 78 per 100,000 person-years. Compare that against roughly 1,600 per 100,000 for major fractures in untreated women at moderate risk. (14) It is also worth knowing that atypical femoral fracture is the one risk of long-term bisphosphonate therapy that genuinely increases with duration, and that the risk falls rapidly, by around 70 percent per year, once treatment stops. (15)
The one thing to act on: if you develop unexplained thigh, groin or hip pain while on a bisphosphonate, report it. That pain can precede a fracture by weeks or months, and imaging the femur is the recommended response. (12)
How long to stay on treatment, and whether a pause makes sense, is a genuinely contested question. The US and UK guidelines do not currently agree with one another, and it is a decision for you and your physician rather than a website. I go through the evidence in detail in my blog post on bisphosphonates.
Femoral Neck Fractures and Arthritis
A number of my clients with osteoporosis also have arthritis. They often wonder if they can strengthen their femoral neck if they also have arthritis.
The good news is that they can, within limits. A research study published in 2017 examined the effects of high impact training on the strength of the femoral neck. (17) The study demonstrated two exciting findings:
- High impact loading had a positive effect on the strength of the femoral neck in as short time as 12 months.
- At the same time, high impact loading did not have “any harmful effect on knee cartilage composition in post-menopausal women with mild knee osteoarthritis”.
However, jumping might not be an appropriate exercise for an individual with more serious joint health problems or a weak pelvic floor. In either case, you should attend to medical issues that prohibit you from jumping.
Conclusion
Many of my clients ask me to review their DEXA report and explain the results, especially as it relates to the femoral neck score. A DEXA scan measures the bone density of an area of your hip called the femoral neck. A fracture of the femoral neck is one of the more debilitating and serious consequences of osteoporosis or osteopenia. Your physician will track this number closely and consider it carefully when diagnosing the health of your bones and recommending an appropriate course of action.
When their scores are lower than they like, patients ask me for things that they can do to increase femoral neck bone density. I strongly encourage them to consider the guidance their physician, especially when pharmaceutical intervention is suggested. At the same time, their physician will often recommend an osteoporosis exercise program. In the post, we cover a graduated and progressive set of exercises that you can help you increase femoral neck bone density. To learn more about exercise and osteoporosis, sign up for my free seven day email course below.
Stronger bones in just 7 days with my free email course.
Femoral Neck Questions and Answers
The questions I am asked most often after someone reads their bone density report.
How serious is osteoporosis of the femoral neck?
A femoral neck T-score of −2.5 or lower meets the diagnostic threshold for osteoporosis, but a low score is not the same as an inevitable fracture. Bone density is one risk factor among several. In fact, the majority of people who go on to break a bone have a femoral neck T-score above −2.5, which is why your age, your fracture history, whether a parent broke a hip, and how likely you are to fall all matter alongside the number itself.
What is femoral neck osteopenia?
Femoral neck osteopenia means the bone density at the neck of your femur falls between −1.0 and −2.5 on the T-score scale. That is below the range expected for a healthy young adult, but above the threshold for osteoporosis. The bodies that write these definitions now prefer the term low bone mass, and they are explicit that people with low bone mass are not necessarily at high fracture risk.
What is the left femoral neck?
The left femoral neck is the short, angled section of bone that connects the long shaft of your left thigh bone to the ball at the top of it, which sits in your hip socket. On a bone density report it appears as a row label, and it is simply telling you which hip was measured. It is not a separate condition, and it is not a different problem from the right femoral neck.
Where is the left femoral neck?
It sits deep inside your left hip, at the very top of the thigh bone, between the long shaft and the ball of the hip joint. It is not something you can feel from the outside, which is part of why the term is unfamiliar to most people until it turns up on a scan report. If you would like to see exactly where it sits, there is an image further up this page.
What is femoral neck BMD?
BMD stands for bone mineral density, and femoral neck BMD is the raw measurement taken at that part of your hip. It is written in grams per square centimetre, so a report might show something like 0.927 g/cm². On its own that number tells you very little, because there is no way to know from it alone whether it is good or poor for someone your age. Your T-score and Z-score are that same measurement translated into something you can compare.
What is the treatment for femoral neck osteoporosis?
Management usually combines several things rather than any single one. Regular weight-bearing and muscle strengthening exercise, tailored to what you can actually do, is recommended at the highest level of evidence the guidelines recognise, and it has been shown to reduce bone loss at the femoral neck specifically. Adequate calcium and vitamin D, and attention to anything that raises your risk of falling, both matter. Some people are also offered medication, and that decision rests on your overall fracture risk rather than on the T-score alone, which is a conversation to have with your physician. I go through the medication evidence in more detail here.
Why is my Ward's area score so much worse?
Ward's area is a small region within the hip that the scanner reports, and it very often shows a much lower number than the femoral neck or the total hip. It is not used for diagnosis. Neither is the greater trochanter. If the worst number on your report is sitting in one of those rows, it is not the number your diagnosis rests on.
Which hip does FRAX use?
FRAX uses femoral neck bone density, and only femoral neck bone density. Readings from other sites are not recommended as substitutes. What no guideline states is which femoral neck to use when both hips have been reported. For diagnosis, the lowest T-score of the right or left femoral neck or total hip is used, never the average of the two sides, and for tracking change over time the mean of both total hips is preferred. In practice most clinicians will use the lower of the two, and it is a fair question to ask your physician which hip they entered. You can read more about fracture risk assessment with FRAX here.
Margaret Martin
Further Readings
References
- Singh A, Sharma A. Incongruent Treatment Recommendations Between Left and Right Hip Bone Mineral Densities. Cureus. 2024;16(9):e69923. doi:10.7759/cureus.69923
- Mounach A, Rezqi A, Ghozlani I, et al. Prevalence and risk factors of discordance between left- and right-hip bone mineral density using DXA. ISRN Rheumatol. 2012;2012:617535. doi:10.5402/2012/617535
- Alele JD, Kamen DL, Hermayer KL, et al. The prevalence of significant left-right hip bone mineral density differences among black and white women. Osteoporos Int. 2009;20:2079-85. doi:10.1007/s00198-009-0915-0
- Hamdy R, Kiebzak GM, Seier E, Watts NB. The prevalence of significant left-right differences in hip bone mineral density. Osteoporos Int. 2006;17:1772-80. doi:10.1007/s00198-006-0192-0
- Shahane A, Lim SY, Bolster MB. Updates on the Role of DXA in the Evaluation and Monitoring of Osteoporosis. Curr Rheumatol Rep. 2025;27:38. doi:10.1007/s11926-025-01205-9
- Hwang HJ, Park SY, Lee SH, Han SB, Ro KH. Differences in bone mineral density between the right and left hips in postmenopausal women. J Korean Med Sci. 2012;27:686-90. doi:10.3346/jkms.2012.27.6.686
- Afzelius P, et al. Dual-energy X-ray Absorptiometry of Both Hips Helps Appropriate Diagnosis of Low Bone Mineral Density and Osteoporosis. Diagnostics. 2017 Jul 9;7(3). pii: E41. doi: 10.3390/diagnostics7030041.
- International Society for Clinical Densitometry. 2023 ISCD Official Positions – Adult. https://iscd.org/official-positions-2023/
- Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9:1137-41.
- International Society for Clinical Densitometry and International Osteoporosis Foundation. 2010 Official Positions on FRAX. https://iscd.org/learn/official-positions/frax-positions/
- Tanner SB, Krueger D, Szalat A, et al. Bilateral Hip DXA Reporting: 2023 Official Positions of the ISCD. J Clin Densitom. 2023;101438. doi:10.1016/j.jocd.2023.101438
- Gregson CL, Armstrong DJ, Bowden J, et al. The 2024 UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2025;20:119. doi:10.1007/s11657-025-01588-3
- Shane E, Burr D, Abrahamsen B, et al. Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014;29:1-23. doi:10.1002/jbmr.1998
- Hayes KN, Winter EM, Cadarette SM, Burden AM. Duration of Bisphosphonate Drug Holidays in Osteoporosis Patients. J Clin Med. 2021;10:1140. doi:10.3390/jcm10051140
- McClung M, Harris ST, Miller PD, et al. Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med. 2013;126:13-20. doi:10.1016/j.amjmed.2012.06.023
Thabet AAE, Alshehri MA, Helal OF, Refaat B. The impact of closed versus open kinetic chain exercises on osteoporotic femur neck and risk of fall in postmenopausal women. J Phys Ther Sci. 2017 Sep;29(9):1612-1616.
Multanen J, Rantalainen T, Kautiainen H, et al. Effect of progressive high-impact exercise on femoral neck structural strength in postmenopausal women with mild knee osteoarthritis: A 12-month RCT. Osteoporos Int. 2017;28:1323-1333. doi:10.1007/s00198-016-3875-1
Comments