Abstract
Background and PurposeAlthough it is widely recognized that hip BMD is reduced in patients with hip fracture, the differences in geometrical parameters such as cortical volume and thickness between subjects with and without hip fracture are less well known.Materials and MethodsFive hundred and sixty two community-dwelling elderly women with hip CT scans were included in this cross-sectional study, of whom 236 had an acute hip fracture. 326 age matched women without hip fracture served as controls. MIAF-Femur software was used for the measurement of the intact contralateral femur in patients with hip fracture and the left femur of the controls. Integral and cortical volumes (Vols) of the total hip (TH), femoral head (FH), femoral neck (FN), trochanter (TR) and intertrochanter (IT) were analyzed. In the FH and FN the volumes were further subdivided into superior anterior (SA) and posterior (SP) as well as inferior anterior (IA) and posterior (IP) quadrants. Cortical thickness (CortThick) was determined for all sub volumes of interest (VOIs) listed above.ResultsThe average age of the control and fracture groups was 71.7 and 72.0 years, respectively. The fracture patients had significantly lower CortThick and Vol of all VOIs except for TRVol. In the fracture patients, cortical thickness and volume at the FN were significantly lower in all quadrants except for cortical volume of quadrant SA (p= 0.635). Hip fracture patients had smaller integral FN volume and cross-sectional area (CSA) before and after adjustment of age, height and weight. With respect to hip fracture discrimination, cortical volume performed poorer than cortical thickness across the whole proximal femur. The ratio of Cort/TrabMass (RCTM), a measure of the internal distribution of bone, performed better than cortical thickness in discriminating hip fracture risk. The highest area under curve (AUC) value of 0.805 was obtained for the model that included THCortThick, FHVol, THRCTM and FNCSA.ConclusionThere were substantial differences in total and cortical volume as well as cortical thickness between fractured and unfractured women across the proximal femur. A combination of geometric variables resulted in similar discrimination power for hip fracture risk as aBMD.
Highlights
Hip fractures are amongst the most severe consequences of osteoporosis and are associated with high morbidity and mortality and a significant reduction in the patient’s quality of life [1]
The ratio of cortical to total bone mass was significantly higher for the TH, femoral neck (FN) and TR volumes of interest (VOIs)
Based on the analysis of 562 participants enrolled in the China Action on Spine and Hip Status (CASH) cross-sectional case–control cohort, our study shows structural differences between elderly women with and without hip fractures, and a combination of selected geometry variables resulted in equivalent discrimination power to the areal bone mineral density (aBMD) model reported previously [11, 24]
Summary
Hip fractures are amongst the most severe consequences of osteoporosis and are associated with high morbidity and mortality and a significant reduction in the patient’s quality of life [1]. Hip fracture patients have a mortality of 20% within the first year [2] and 10 to 20% of hip fracture individuals can no longer live independently [3]. Hip fracture risk depends on the integrity of the proximal femur and the likelihood of experiencing forces that exceed bone strength [4]. The geometrical integrity of the hip is compromised and the risk of falling increases, resulting in older individuals having an increasing risk of hip fracture. It is important to identify individuals at high risk of fracture. It is widely recognized that hip BMD is reduced in patients with hip fracture, the differences in geometrical parameters such as cortical volume and thickness between subjects with and without hip fracture are less well known
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