RESUMO
BACKGROUND: Hip geometric mechanics indicates a mechanical study of hip structure (cortical thickness) based on dual energy X-ray absorptiometry images, which is a better compensation for the deviation of bone density. The fracture risk assessment tool (FRAX) can combine fracture probability with multiple clinical risk factors and bone density of the femoral neck to predict the probability of hip fracture within 10 years and the probability of major osteoporotic fractures (spine, forearm, hip or shoulder fracture). OBJECTIVE: To analyze the hip geometry mechanics and the correlation between the FRAX@ tool and fractures in middle-aged and elderly women, and to explore the clinical significance of the combination method to predict the risk of fragility fracture in middle-aged and elderly women. METHODS: A retrospective study of 1 089 middle-aged female subjects was conducted. According to the questionnaire, there were 225 cases of fractures and 864 cases of non-fractures. Bone mineral density was measured using a dual-energy X-ray absorptiometry, and hip geometrical parameters were analyzed using HSA software: cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), cross-sectional modulus (Z), cortical bone thickness (Cort) and the buckling ratio (BR) value. The FRAX@ tool was used to calculate the fracture rate at the main site and hip fracture rate over the next 10 years. The study was approved by the Ethics Committee of Fujian Institute of Traditional Chinese Medicine. RESULTS AND CONCLUSION: The age of the fracture group was significantly higher than that of the non-fracture group. The hip geometrical parameters of the two groups were compared: lumbar vertebra bone density, femoral neck bone density, CSA, CSMI, Cort, Z were significantly higher in the non-fracture group than the fracture group, while BR was lower in the non-fracture group than the fracture group. Logistic regression analysis of hip geometry mechanics indicated that Cort was a possible protective factor for fracture (odds ratio=0.000, 95% confidence interval: 0.000-0.000). FRAX calculation and analysis of different age groups indicated that the fracture rate at the main site and hip fracture rate of the fracture group were significantly higher than those of the non-fracture group in the next 10 years. In conclude, there is a significant correlation between hip geometric mechanics and fracture. The Cort of the femoral neck is a possible protective factor for fracture, and FRAX@ has a clinical guiding value for predicting fracture. The combination of the two can better predict osteoporotic fracture.
RESUMO
<p><b>Background</b>Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients.</p><p><b>Methods</b>We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters (neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]) were recorded. Student's t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type.</p><p><b>Results</b>Statistically significant differences in NSA (137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P < 0.001), CEA (37.62 ± 6.77° vs. 43.11 ± 7.09°, t = 5.597, P < 0.001), FND (35.21 ± 3.25 mm vs. 34.09 ± 3.82 mm, t = 2.233, P = 0.027), and FNAL (99.30 ± 7.91 mm vs. 103.58 ± 8.39 mm, t = 3.715, P < 0.001) were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes (all P < 0.001). The greater NSA was the risk factor for femoral neck fractures (odds ratio [OR]: 0.70, P < 0.001), greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures (OR: 1.15, 1.17, all P < 0.001), and greater FND was a protective factor for femoral intertrochanteric fractures (OR: 0.74, P < 0.001).</p><p><b>Conclusions</b>We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should be considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.</p>
RESUMO
Fragility fracture rate is increased in type 2 diabetes patients despite of higher bone mineral density than non-diabetes control subjects. Vertebral fractures are usually asymptomatic; therefore, morphometric radiologic evaluation should be considered especially for diabetes patients. Bone quality may more contribute to the increased risk of osteoporotic fractures in patients with type 2 diabetes than bone mass. Hip geometry, cortical porosity, and trabecular bone score have been studied as bone quality parameters by imaging in type 2 diabetes mellitus.