Introduction: The purpose of the present study was to evaluate the value of radiographic measurements of the proximal femur as predictive factors for hip fracture in the elderly population independent of bone mineral density.
Material and methods: The study included 142 consecutive patients operated on for a hip fracture (group 1) and 86 healthy individuals without a hip fracture (group 2). The geometry of the contralateral nonfractured proximal femur in patients from group 1 was evaluated in comparison with healthy individuals from group 2. Anteroposterior pelvic roentgenograms were assessed to measure the geometric parameters of the proximal femur including femoral neck width, Q angle, medial cortical thickness (MCT), lateral cortical thickness (LCT), and true moment arm (TMA) for all hips. Lunar dual-energy X-ray absorptiometry (DXA) was used for bone mineral density measurements in both the fracture and control groups. Multivariate regression analysis was performed to determine the main predictive factors. A receiver operating characteristic curve was constructed for TMA to test the various cut-off points in predicting hip fracture.
Results: Regarding geometric measurement parameters, group 1 had significantly lower MCT and LCT values. The mean femoral neck width (FNW) and Q angle were significantly higher in group 1. Furthermore, TMA was also found to be significantly greater in patients with hip fracture compared to controls, 85 ±14 mm and 66 ±12 mm, respectively (p < 0.001). The mean TMA was also significantly greater in group 1 for both age groups (≤ 65 or > 65 years) (p < 0.001).
Conclusions: True moment arm may provide the most valuable radiographic information as a predictor for hip fracture in the elderly.