The diagnostic and prognostic value of measuring femoral cortical bone thickness in patients with hip fracture — ASN Events
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The diagnostic and prognostic value of measuring femoral cortical bone thickness in patients with hip fracture (#134)

Aung Lynn 1 , Srikusalanukul W 2 , Fisher A 2 3
  1. Departments of Orthopaedic Surgery, Canberra Hospital, Lyons, ACT, Australia
  2. Geriatric Medicine2, The Canberra Hospital, Garran, ACT , Australia
  3. Australian National University Medical School, Canberra, ACT, Australia

Objectives: To evaluate femoral cortical bone thickness in patients with hip fracture (HF) and its association with fracture type, biomarkers of bone-mineral metabolism and clinical characteristics.

Materials and Methods: In 367 (267 females) patients (mean age 82.9 ± 8.5 years) admitted in 2012-2014 with HF (191 cervical, 176 trochanteric) we measured on X-rays of the fractured and opposite side the femoral cortical thickness index (FCTI): mean ratio of shaft diameter minus medullary diameter to shaft diameter at 9/10/11cm distal to the lesser trochanter. Associations between FCTI and clinical characteristics, biomarkers of bone turnover and mineral metabolism were analysed.

Results: On the fractured side, in both females and males, mean FCTI was significantly lower in trochanteric compared to cervical HF (0.397 ± 0.081 vs. 0.437 ± 0.082, p=0.000). On the non-fractured side, mean FCTI was significantly higher than on the fractured in both cervical (0.479 ± 0.078, p=0.000) and trochanteric (0.455 ± 0.077, p=0.000). Among patients with cervical HF, FCTI was lower in females than males on both fractured (0.426 ± 0.081 vs. 0.467 ± 0.078, p=0.001) and opposite sides (0.467 ± 0.075 vs. 0.505 ± 0.078, p=0.003). FCTI was significantly and negatively associated with age, female sex, dementia, cardiac failure, walking aid usage, biomarkers of bone formation (osteocalcin, P1NP), resorption (βCTx) and transferrin saturation, and positively with haemoglobin and albumin levels. Multivariate regression revealed as significant independent determinants of FCTI age (p=0.000), female sex (p=0.006), βCTx (p=0.010) [all negative] and albumin (p=0.022) [positive].

Conclusions: Femoral cortical bone thickness is significantly lower on the fractured compared to opposite side, in patients with trochanteric compared to cervical HF, and in females compared to males. Lower FCTI, which is independently determined by advanced age, female sex, higher levels of bone resorption and hypoalbuminaemia, appears as a promising risk factor for fragility and fractures.