Bone Mineral Density, Hip Axis Length and Risk of Hip Fracture in Men: Results from the Cornwall Hip Fracture Study

Abstract

Bone mineral density (BMD) and hip axis length (HAL) are important determinants of fracture risk in women. There are, however, few data concerning their predictive risk in men. The aim of this study was to determine the relationship between BMD, HAL and the risk of hip fracture in men. A case-control design was used. Cases were men aged 50 years and over with a minimal-trauma hip fracture admitted to the Royal Cornwall Hospital, Truro, during 1995-1997. Controls were recruited from a large general practice within the catchment area of the hospital. Subjects were invited for assessment of BMD at the lumbar spine and proximal femur, using dual-energy X-ray absorptiometry. HAL was assessed using machine software. Data concerning BMD were available in 62 fracture cases and 100 controls. After adjusting for age, height and weight, a reduction in BMD was associated with a significant increase in the risk of hip fracture [odds ratio (OR) 1.8-4.0 per standard deviation (SD) reduction, depending on site]. HAL was similar in both fracture and control groups (12.0 cm vs 12.0 cm). After adjusting for height, there was no association between HAL and the risk of hip fracture (OR per 1 SD increase in HAL = 0.9; 95% confidence interval 0.6, 1.3). Compared with those with a cervical fracture (n = 31), those with an intertrochanteric fracture (n = 31) had lower BMD at all skeletal sites, though this was significant for the trochanteric site only. It is concluded that BMD though not hip axis length is a risk factor for low-trauma hip fracture in Caucasian men.

Is Distal Forearm Fracture in Men due to Osteoporosis?

“…Francis et al [3] found 56% of men with vertebral fractures to be osteoporotic at the lumbar spine (T-score 5-2.5). Pande et al [13] found 83% of men with hip fractures to be osteoporotic at the femoral neck and 36% at the lumbar spine, but the men in this study were older (mean 78.4 years compared with 60.97 years for our study).…”

“…In men with vertebral fractures the greatest reduction in BMD was seen at the lumbar spine [3]. Similarly, the greatest reduction in BMD in men with hip fractures was seen at the femoral neck [13]. It is possible that this is the result of differential rates of loss resulting in a predisposition to particular fracture types.…”

Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density

“…7,8 This evidence, however, mainly derives from studies carried out in females, 9-13 whereas contradictory results characterize studies carried out in males. [14][15][16][17][18][19][20] Authors' opinions seem to vary widely about the ability of the neck shaft angle (NSA), one of the PFG factors, to predict osteoporotic hip fractures in males, [14][15][16]21 whereas its association with the risk of hip fracture in females 10,11,14,22 is generally accepted. Gender differences in the hip anatomy 23 have been put forward as a possible explanation for the different relationship of NSA with the hip-fracture risk between genders, whereas geographic and racial differences 24 among the examined male populations have been advocated as a possible cause of authors' discrepancies on the relationship between NSA and the hip-fracture risk in males.…”

Evaluation of the Singh index and femur geometry in osteoporotic women

“…Other studies have noted that HAL is linked to different types of fracture, with longer HAL linked to cervical (intra-capsular) rather than inter-trochanteric fracture [38,43]. In contrast, not all studies have found a significant association between HAL and fracture [21,44,45]. Pulkinen et al suggested that structural parameters of trabecular bone geometry predict in vitro failure loads of the proximal femur with similar accuracy as DXA, when using appropriate image analysis technology.…”