Site-Specific Differences in Bone Mineral Density of Proximal Femur Correlate with the Type of Hip Fracture

Author:

Li Ning1,Yuan Yi2,Yin Lu3,Yang Minghui1,Liu Yandong2,Zhang Wenshuang2,Ma Kangkang2,Zhou Fengyun2,Cheng Zitong2,Wang Ling2,Cheng Xiaoguang2

Affiliation:

1. Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China

2. Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China

3. Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Beijing 100037, China

Abstract

The aim of this study was to investigate whether site-specific differences in bone mineral density (BMD) of proximal femur correlate with the type of hip fracture using quantitative computed tomography. Femoral neck (FN) fractures were classified as nondisplaced or displaced subtypes. Intertrochanteric (IT) fractures were classified as A1, A2, or A3. The severe hip fractures were identified as displaced FN fractures or unstable IT fractures (A2 and A3). In total, 404 FN fractures (89 nondisplaced and 317 displaced) and 189 IT fractures (76 A1, 90 A2, and 23 A3) were enrolled. Areal BMD (aBMD) and volumetric BMD (vBMD) were measured in the regions of total hip (TH), trochanter (TR), FN, and IT of the contralateral unfractured femur. IT fractures exhibited lower BMD than FN fractures (all p ≤ 0.01). However, unstable IT fractures had higher BMD compared with stable ones (p < 0.01). After adjusting for covariates, higher BMD in TH and IT were associated with IT A2 (A1 vs. A2: odds ratios (ORs) from 1.47 to 1.69, all p < 0.01). Low bone measurements were risk factors for stable IT fractures (IT A1 vs. FN fracture subtypes: ORs from 0.40 to 0.65, all p < 0.01). There are substantial site-specific differences in BMD between IT fractures A1 and displaced FN fractures. Higher bone density was associated with unstable IT fracture when compared with stable ones. The understanding of biomechanics of various fracture types could help to improve the clinical management of these patients.

Funder

National Key R&D Program of China

Beijing Hospitals Authority Youth Programme

Beijing Municipal Health Commission

Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support

Publisher

MDPI AG

Subject

Clinical Biochemistry

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