CLINICAL RESEARCH
Morphological characteristics of the proximal femur in elderly patients with hip fractures: a case-control study
Submission date: 2017-06-16
Final revision date: 2017-10-01
Acceptance date: 2017-10-17
Publication date: 2017-11-21
Arch Med Sci Civil Dis 2017;2(1):161-167
KEYWORDS
TOPICS
ABSTRACT
Introduction: Owing to the diverse design, measurement methods and ethnic differences, the influence of the proximal femur geometry on hip fractures is still unclear. Therefore, this study aimed to investigate morphological characteristics of the proximal femur in senile patients with hip fractures on three-dimensional images.
Material and methods: One hundred and sixteen women and 38 men with hip fractures were included in the fracture group. The control group included 74 women and 63 men. The geometrical parameters of the proximal femur were measured after three-dimensional reconstruction. The femoral neck width (FNW), femoral neck length (FNL), femoral head height (FHH), femoral head diameter (FHD), neck shaft angle (NSA) and offset were measured and statistically analyzed.
Results: The NSA in fracture cases was significantly larger than controls in both men and women (130.18 vs. 126.93, p = 0.001; 131.07 vs. 128.68, p < 0.001, respectively). Moreover, a lower total hip bone mineral density (BMD) in fracture cases was found in both sexes (0.725 vs. 0.812, p = 0.001; 0.743 vs. 0.830, p < 0.001, respectively). In multiple logistic regression analysis, a larger NSA and a lower total hip BMD were independent predictors for hip fractures in both men and women (OR = 1.143 and 1.171, p = 0.010 and 0.016, respectively). However, the FNL was an independent predictor for hip fractures only for women (OR = 1.201, 95% CI: 1.106–1.305, p < 0.001).
Conclusions: A larger NSA and a lower BMD were independent predictors for hip fractures of senile patients in both sexes. Moreover, a longer FNL was an independent risk factor for patients with hip fractures in women. As a result, we hypothesized that the geometrical measurement of the proximal femur on three-dimensional images might be appropriate.
Material and methods: One hundred and sixteen women and 38 men with hip fractures were included in the fracture group. The control group included 74 women and 63 men. The geometrical parameters of the proximal femur were measured after three-dimensional reconstruction. The femoral neck width (FNW), femoral neck length (FNL), femoral head height (FHH), femoral head diameter (FHD), neck shaft angle (NSA) and offset were measured and statistically analyzed.
Results: The NSA in fracture cases was significantly larger than controls in both men and women (130.18 vs. 126.93, p = 0.001; 131.07 vs. 128.68, p < 0.001, respectively). Moreover, a lower total hip bone mineral density (BMD) in fracture cases was found in both sexes (0.725 vs. 0.812, p = 0.001; 0.743 vs. 0.830, p < 0.001, respectively). In multiple logistic regression analysis, a larger NSA and a lower total hip BMD were independent predictors for hip fractures in both men and women (OR = 1.143 and 1.171, p = 0.010 and 0.016, respectively). However, the FNL was an independent predictor for hip fractures only for women (OR = 1.201, 95% CI: 1.106–1.305, p < 0.001).
Conclusions: A larger NSA and a lower BMD were independent predictors for hip fractures of senile patients in both sexes. Moreover, a longer FNL was an independent risk factor for patients with hip fractures in women. As a result, we hypothesized that the geometrical measurement of the proximal femur on three-dimensional images might be appropriate.
REFERENCES (31)
1.
Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 1993; 94: 646-50.
2.
Dash SK, Panigrahi R, Palo N, Priyadarshi A, Biswal M. Fragility hip fractures in elderly patients in Bhubaneswar, India (2012-2014): a prospective multicenter study of 1031 elderly ptients. Geriatr Orthop Surg Rehabil 2015; 6: 11-5.
3.
Diamantopoulos AP, Rohde G, Johnsrud I, et al. Incidence rates of fragility hip fracture in middle-aged and elderly men and women in southern Norway. Age Ageing 2012; 41: 86-92.
4.
Cauley JA, Cawthon PM, Peters KE, et al. Risk factors for hip fracture in older men: the osteoporotic fractures in men study (MrOS). J Bone Miner Res 2016; 31: 1810-9.
5.
Lee SH, Chen IJ, Li YH, Fan Chiang CY, Chang CH, Hsieh PH. Incidence of second hip fractures and associated mortality in Taiwan: a nationwide population-based study of 95,484 patients during 2006-2010. Acta Orthop Traumatol Turc 2016; 50: 437-42.
6.
Maravic M, Ostertag A, Urena P, Cohen-Solal M. Dementia is a major risk factor for hip fractures in patients with chronic kidney disease. Osteoporos Int 2016; 27: 1665-9.
7.
Beck TJ, Ruff CB, Warden KE, Scott WW Jr, Rao GU. Predicting femoral neck strength from bone mineral data. A structural approach. Invest Radiol 1990; 25: 6-18.
8.
Wainwright SA, Marshall LM, Ensrud KE, et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab 2005; 90: 2787-93.
9.
Faulkner KG, Cummings SR, Black D, Palermo L, Gluer CC, Genant HK. Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. J Bone Miner Res 1993; 8: 1211-7.
10.
Frisoli A Jr, Paula AP, Pinheiro M, et al. Hip axis length as an independent risk factor for hip fracture independently of femural bone mineral density in Caucasian elderly Brazilian women. Bone 2005; 37: 871-5.
11.
Dincel VE, Sengelen M, Sepici V, Cavusoglu T, Sepici B. The association of proximal femur geometry with hip fracture risk. Clin Anat 2008; 21: 575-80.
12.
Han J, Hahn MH. Proximal femoral geometry as fracture risk factor in female patients with osteoporotic hip fracture. J Bone Metab 2016; 23: 175-82.
13.
Gomez Alonso C, Diaz Curiel M, Hawkins Carranza F, Perez Cano R, Diez Perez A. Femoral bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Osteoporos Int 2000; 11: 714-20.
14.
Tang ZH, Yeoh CS, Tan GM. Radiographic study of the proximal femur morphology of elderly patients with femoral neck fractures: is there a difference among ethnic groups? Singapore Med J 2016; DOI: 10.11622/smedj.2016148.
15.
Imren Y, Sofu H, Dedeoglu SS, Desteli EE, Cabuk H, Kir MC. Predictive value of different radiographic parameters evaluating the proximal femoral geometry for hip fracture in the elderly: what is the role of the true moment arm? Arch Med Sci Civil Dis 2016; 1: 58-62.
16.
Fu X, Xu GJ, Li ZJ, et al. Three-dimensional reconstruction modeling of the spatial displacement, extent and rotational orientation of undisplaced femoral neck fractures. Medicine (Baltimore) 2015; 94: e1393.
17.
Liu S, Zuo J, Li Z, et al. Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type IV hips. Int Orthop 2017; 41: 707-13.
18.
Lee DH, Jung KY, Hong AR, et al. Femoral geometry, bone mineral density, and the risk of hip fracture in premenopausal women: a case control study. BMC Musculoskelet Disord 2016; 17: 42.
19.
Gnudi S, Sitta E, Pignotti E. Prediction of incident hip fracture by femoral neck bone mineral density and neck-shaft angle: a 5-year longitudinal study in post-menopausal females. Br J Radiol 2012; 85: e467-73.
20.
Ripamonti C, Lisi L, Avella M. Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density. Br J Radiol 2014; 87: 20130358.
21.
Wang Q, Teo JW, Ghasem-Zadeh A, Seeman E. Women and men with hip fractures have a longer femoral neck moment arm and greater impact load in a sideways fall. Osteoporos Int 2009; 20: 1151-6.
22.
Pulkkinen P, Eckstein F, Lochmuller EM, Kuhn V, Jamsa T. Association of geometric factors and failure load level with the distribution of cervical vs. trochanteric hip fractures. J Bone Miner Res 2006; 21: 895-901.
23.
Frost HM. Skeletal structural adaptations to mechanical usage (SATMU): 1. Redefining Wolff’s law: the bone modeling problem. Anat Rec 1990; 226: 403-13.
24.
Rafferty KL. Structural design of the femoral neck in primates. J Hum Evol 1998; 34: 361-83.
25.
Partanen J, Jamsa T, Jalovaara P. Influence of the upper femur and pelvic geometry on the risk and type of hip fractures. J Bone Miner Res 2001; 16: 1540-6.
26.
Frost HM. Skeletal structural adaptations to mechanical usage (SATMU): 2. Redefining Wolff’s law: the remodeling problem. Anat Rec 1990; 226: 414-22.
27.
Leslie WD, Lix LM, Morin SN, et al. Hip axis length is a FRAX- and bone density-independent risk factor for hip fracture in women. J Clin Endocrinol Metab 2015; 100: 2063-70.
28.
Center JR, Nguyen TV, Pocock NA, et al. Femoral neck axis length, height loss and risk of hip fracture in males and females. Osteoporos Int 1998; 8: 75-81.
29.
Gnudi S, Ripamonti C, Lisi L, Fini M, Giardino R, Giavaresi G. Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women. Osteoporos Int 2002; 13: 69-73.
30.
Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res 2005; 20: 1185-94.
31.
Li Y, Lin J, Cai S, et al. Influence of bone mineral density and hip geometry on the different types of hip fracture. Bosn J Basic Med Sci 2016; 16: 35-8.
| ISSN: | 2451-0637 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
