Weak psoas and spine extensors potentially predispose to hip fracture

Abstract

Introduction: We performed a computed tomography analysis of muscle composition characteristics in hip fracture patients and non-hip fracture controls. Methods: In total, 43 patients (9 men, 34 women) were included in the hip fracture group, matched 1 to 1 with non-hip fracture controls. Muscle cross-sectional areas were measured in axial CT scan at the body level of the 4th lumbar vertebra (L4), intervertebral disc level between the 5th lumbar vertebra and the 1st sacral vertebra (L5-S1) and just below level of the lesser trochanter (LT). Attenuation was also evaluated through the mean Hounsfield unit (HU) in these areas. Results: The cross-sectional area per weight (CSA/Wt, mm2/kg) of psoas muscle and extensor muscles of the spine showed a significant difference between the 2 groups at both L4 (9.7 vs. 12.4, p < 0.001 and 26.3 vs. 29.2, p = 0.025) and L5-S1 (9.6 vs. 11.5, p = 0.001 and 8.8 vs. 10.3, p = 0.041) levels. In addition, the HU of these muscles differed significantly between the 2 groups at both L4 (33.3 vs. 47.6, p < 0.001 and 13.7 vs. 30.2, p < 0.001) and L5-S1 (39.7 vs. 52.6, p < 0.001 and 3.8 vs. 15.1, p = 0.012) levels. There was no difference in abdominal wall, gluteal, or thigh compartment musculature between the groups. Conclusions: Poorer quantity and quality of psoas muscle and extensor muscles of the spine rather than whole body muscles may contribute to falls and were characteristic features of the hip fracture patients in this series. These findings should be considered when recommending a preventive exercise and rehabilitation protocol.

Recent advances in the identification of related factors and preventive strategies of hip fracture

“…Another established fall factor that should be corrected is a decline in muscle quality in certain areas. The fall risk is related to the mass of the psoas major muscle and the extensor muscle of the spine, and weak psoas and spine extensors may increase the risk of fracture ( 78 ). In addition, a cohort study involving 7,575 women aged 75 or older showed that neuromuscular injury (gait speed and tandem walk) and poor vision were important and independent predictors of hip fracture risk ( 9 ).…”

Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: results from the UK Women’s Cohort Study

“…Higher fat mass could also increase bone strength through increased mechanical loading and enhanced oestrogen production [ 38 ]. Low muscle mass and strength of the hip flexor muscles and spine extensors have also been associated with an increased risk of hip fracture [ 40 ], possibly due to reduced balance and mobility. Weight management may therefore be an important consideration in reducing hip fracture risk in vegetarians, but further research is required to explore the roles of BMI and body composition in hip fracture risk in vegetarians and meat-eaters.…”

Paraspinal Muscle Degeneration: A Potential Risk Factor for New Vertebral Compression Fractures After Percutaneous Kyphoplasty

“…As a joint adverse event of imbalance, falling is also a well-known factor in fractures among older adults. 30 Kim et al 31 suggested that a weak PM should be used as a significant predictor of falls and hip fractures in osteoporotic patients. Statistically, falling accounts for 87% of all types of fractures in the elderly, and these fractures are virtually always due to low-impact injuries in osteoporotic bones.…”