Document Type

Journal Article

Publication Title

Journal of Bone and Mineral Research

Volume

38

Issue

6

First Page

869

Last Page

875

PubMed ID

36798967

Publisher

Wiley

School

School of Medical and Health Sciences / Nutrition and Health Innovation Research Institute

RAS ID

60179

Comments

This is the accepted version of the following article: Prince, R., Khoo, B., Brown, K., & Lewis, J. (2023). Differences in femoral neck and trochanteric structure in elderly women prior to hip fracture: Role in hip fracture prediction. Journal of Bone and Mineral Research, 38(6), 869-575, which has been published in final form at https://doi.org/10.1002/jbmr.4789.

Prince, R., Khoo, B., Brown, K., & Lewis, J. (2023). Differences in femoral neck and trochanteric structure in elderly women prior to hip fracture: Role in hip fracture prediction. Journal of Bone and Mineral Research, 38(6), 869-575. https://doi.org/10.1002/jbmr.4789

Abstract

We examine the hypothesis that internal dual-energy X-ray absorptiometry (DXA) structural variables measured at the femoral neck and trochanter cross sections will improve prediction of fractures at these sites in addition to areal BMD (aBMD). We present an analysis of the internal distribution of bone at the site of these fractures using baseline hip DXA measurement of 1151 participants, mean age (SD) 75 (3) years, in the 14.5-year Perth Longitudinal Study of Aging in Women. Structural differences at the femoral neck (FN) and trochanter (TR) cross sections were compared in 69 participants who went on to sustain femoral neck fracture (FNF) and 59 participants who went on to sustain trochanter fracture (TRF), on average 10 years later, to those who did not fracture. The new structural variables, in addition to aBMD and bone width (W), were Sigma (distribution of bone within scanned area) and Delta (distance between center-of-mineral mass and geometric center), which can be assessed by current DXA programs. At baseline, compared with nonfracture cases, FNF cases had a FNaBMD 7% lower, a FNWidth 3% higher and a FNDelta 29% higher, associated with reduced bone in the superior segment. In FNF Cox proportional hazard analysis, age (hazard ratio [HR 1.39]), total hip aBMD (THaBMD; 0.79), and Delta (1.70) were significant. Addition of FN Delta to the base case of THaBMD and age improved the C statistic from 0.62 to 0.69, p = 0.01. At baseline, TRF cases had a 15% lower TRaBMD with minor differences in Sigma (1%) and Width (2%). In TRF Cox analysis, neither addition of Sigma nor Width improved the model that included age and THaBMD as predictors and did not alter the C-statistic of 0.81. In conclusion, adding measurement of FN Delta, an assessment of superior sector bone loss, to hip aBMD and age substantially improved clinical FNF prediction in older women. © 2023 American Society for Bone and Mineral Research (ASBMR).

DOI

10.1002/jbmr.4789

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