Effects of Hip Structure Analysis Variables on Hip Fracture: A Propensity Score Matching Study

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.

Beyond Bone Mineral Density: A New Dual X-Ray Absorptiometry Index of Bone Strength to Predict Fragility Fractures, the Bone Strain Index

“…Studies showed that HSA results are important in predicting the occurrence of hip fracture ( 68 , 69 ). However, the usage in clinical practice is still limited by the problematic interpretation of the several structural parameters associated with measured BMD and lack of evidence in clinical practice regarding fracture prediction ( 5 ).…”

Higher BMI and lower femoral neck strength in males with type 2 diabetes mellitus and normal bone mineral density

“…19 Therefore, HSA can be introduced to predict the risk of hip fracture. 20 In this retrospective study, we found that femur neck and total femur BMDs were higher in T2DM-overweight group than in T2DM-normal weight group, and higher in T2DM-obesity group than in T2DM-overweight group(Table 2). The incidences of obesity and osteoporosis are increasing over the period of time from childhood to old age.…”

Osteoporosis in 10 years time: a glimpse into the future of osteoporosis

“…Addition of HSA to standard BMD measurements can improve the prediction of hip fracture. 32 , 33 Of note, HSA parameters are not influenced substantially by antiosteoporotic treatments and should be considered a nonmodifiable risk factor for fractures. 32 FEA is another computerized method that estimates the microarchitectural geometry of the hip.…”