Abstract
The purpose of this retrospective study was to compare the hip structural analysis (HSA) levels of patients with those of a hip fracture group. All patients with an initial hip fracture who were older than or equal to 65 years old and admitted to our hospital between March 2018 and January 2019 were eligible for this study. During the study period, 134 hip fracture patients aged 65 years and older were admitted to the study institution, and a total of 51 hip fracture patients were ultimately assigned to the patient group. Age, sex, body mass index (BMI), skeletal muscle index (SMI), and vitamin D were matched in the two groups (hip fracture (HF) group vs. non-hip fracture group) using propensity score matching (PSM) without any statistical differences. Following propensity score matching, 51 patients in the HF group and 51 patients in the non-HF group were included in the study, respectively. Hip axis length (p = 0.031), neck-shaft angle (p = 0.043), width of intertrochanter (p = 0.005), and femur shaft (p = 0.01) were found to be significantly higher in the HF group (107.31 (mean) ± 9.55 (standard deviation, SD), 131.11 ± 5.29, 5.57 ± 0.58, and 3.05 ± 0.23, respectively) than in the non-HF group (102.07 ± 14.15, 128.85 ± 5.81, 5.29 ± 0.38, and 2.92 ± 0.23, respectively). However, cross-sectional area (CSA) of femur neck (p = 0.005) and femur shaft (p = 0.01) as well as cortical thickness (CT) of femur neck (p = 0.031) and femur shaft (p = 0.031) were found to be significantly lower in the HF group (1.93 ± 0.44, 3.18 ± 0.83, 0.11 ± 0.02, and 0.38 ± 0.09, respectively) than in the non-HF group (2.12 ± 0.46, 3.57 ± 0.78, 0.13 ± 0.03, and 0.47 ± 0.11, respectively). The HSA showed excellent sensitivity (82.4% to 90.2%). HSA is an important factor in predicting the occurrence of hip fracture. Therefore, not only should bone mineral density (BMD) be considered clinically, but it is also important to look closely at HSA for risk of hip fracture.
Highlights
As the global population ages, the life expectancy among the elderly will continue to increase [1]
The main finding of this study was that hip structural analysis (HSA) affects the occurrence of hip fractures
We analyzed the effects on HSA after ensuring that both the groups were statistically similar through propensity score matching (PSM)
Summary
As the global population ages, the life expectancy among the elderly will continue to increase [1]. With the increasing prevalence of various chronic diseases, incidence of osteoporosis-caused fragility fractures is on the rise in the elderly [2]. Among the osteoporotic fractures, hip fractures greatly increase morbidity and mortality rates among the elderly, thereby significantly reducing their qualities of life for the rest of their lives [3,4,5]. Bone mineral density (BMD) measurement using dual-energy X-ray absorptiometry (DXA) equipment is the most widely-used diagnostic tool for osteoporosis, and along with having been used for a long time, is the most widely-used method for predicting fractures and evaluating prognosis [8]. Some of the representative methods are trabecular bone score (TBS), hip structural analysis (HSA), and body composition including skeletal muscle index (SMI) [9,10,11,12,13]
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