Quantitative computed tomography analysis of proximal femur bone mineral density and its relation to hip fracture risk

Background: Hip fractures significantly reduce the quality of life and mobility of older adults. This study aimed to analyze the correlation between volumetric bone mineral density (vBMD) in different regions of the proximal femur as measured by quantitative computed tomography (QCT) and various subtypes of hip fractures.

Methods: This case-control study included patients over the age of 65 years admitted to Huadong Hospital Affiliated to Fudan University for hip fractures from November 2022 to December 2023; additionally, patients from the health examination center or outpatient center treated during the same period were included as a control group. Age and gender were matched to eliminate potential confounding factors. The vBMD at the femoral neck (FN), intertrochanteric (IT), and subtrochanteric (ST) regions in the hip fracture groups [FN fracture (FNF) and IT fracture (ITF)] and control group were measured using QCT.

Results: A total of 107 patients with FNF, 77 with ITF, and 72 controls were included. After matching for age and gender was completed, 48 individuals were included in each of the three groups. The vBMD at the IT, FN, and ST regions were significantly lower in patients with hip fractures compared to those in the control group for both genders (P<0.001). The vBMD of the FN and IT regions of females in the ITF group was lower than that of those in the FNF group (P<0.05). Additionally, the vBMD of the ST region in both genders was lower in the ITF group than in the FNF group (male: P<0.05; female: P<0.001). In all three groups, females had a significantly lower vBMD in all three regions compared to males (P<0.001). The decline in vBMD was more pronounced in the ITF group than in the FNF group for both genders, with the largest reduction compared to controls observed in the ST region of females in the ITF group.

Conclusions: Older adult individuals with a lower hip vBMD are more susceptible to experiencing osteoporotic hip fracture than are those with a normal vBMD. Reduced ST vBMD may serve as an indicator for ITF, especially among females.