New quantitative ultrasound techniques for bone analysis at the distal radius in hip fracture cases: differences between femoral neck and trochanteric fractures

Abstract

SummaryBackground. Ample evidence on etiological and pathological differences between femoral neck and trochanteric fracture cases suggests the possibility of individualized treatment. There are many issues related to areal bone mineral density and other quantitative computed tomography parameters of the proximal femur. Although osteoporosis is a systemic problem, little has been reported regarding differences in bone structural parameters, including bone mineral density, between them in regions other than the proximal femur. Methods. Participants were consecutive female patients >50 years of age admitted to the Saiseikai Suita Hospital (Osaka prefecture, Japan) for their first hip fracture between January 2012 and September 2014. Cortical thickness (CoTh, mm), volumetric trabecular bone mineral density (TBD, mg/cm 3 ), and elastic modulus of trabecular bone (EMTb, GPa) were obtained as the new QUS parameters using the LD-100 system (Oyo Electric, Kyoto, Japan).The mean values of these parameters were compared between femoral neck and trochanteric fracture cases. In addition, correlations between age and each QUS parameter were investigated for each fracture type. A receiver operating characteristic (ROC) curve analysis was performed to examine the degree of effect each parameter on the fracture types. The area under the curve (AUC) for each parameter was compared to the AUC for age. Results. There were 63 cases of femoral neck fracture (mean age, 78.2 years) and 37 cases of trochanteric fracture (mean age, 85.9 years). Mean TBD and EMTb were significantly higher for femoral neck fractures. There were significant negative correlations between QUS parameters and age for femoral neck fractures (P < 0.005). The regression lines for femoral neck fractures were above those for trochanteric fractures for TBD and EMTb. AUCs were 0.72 for age, and 0.61, 0.65, and 0.65 for CoTh, TBD, and EMTb, respectively. Conclusions. The new QUS parameters indicated that TR fracture cases were more osteoporotic than were FN fracture cases, even at the distal radius. There might be systemic differences between them, in addition to localized factors at the proximal femur. BackgroundHip fracture, one of the primary osteoporotic fractures, has a profound influence not only on decreasing healthy life expectancy but also the length of the lifespan overall. Although the recent decline of its incidence has been suggested even in Japan, the number of new patients continues to increase tremendously due to the rapid increase in the elderly population (1). Fracture prevention is a major health and socioeconomic concern in many countries. There are two types of hip fracture, namely femoral neck fracture (FN fracture) and trochanteric fracture (TR fracture). There is a lot of evidence to indicate etiological and pathological differences between them, suggesting the possibility of individualized treatment to improve prevention of hip fractures (2, 3). Among these differences, there are many issues related to areal bone mineral density (areal BMD) a...