Abstract
Background
Osteoporosis is a common disease in elderly, characterized by poor bone quality as a result of alterations affecting trabecular bone. However, recent studies have described also an important role of alterations of cortical bone in the physiopathology of osteoporosis. Although dual-energy X-ray absorptiometry (DXA) is a valid method to assess bone mineral density, in the presence of comorbidities real bone fragility is unable to be evaluated. The number of hip fractures is rising, especially in people over 85 years old.
Aims
The aim is to evaluate an alternative method so that it can indicate fracture risk, independent of bone mineral density (BMD). Femoral cortical index (FCI) assesses cortical bone stock using femur X-ray.
Methods
A retrospective study has been conducted on 152 patients with hip fragility fractures. FCI has been calculated on fractured femur and on the opposite side. The presence of comorbidities, osteoporosis risk factors, vitamin D levels, and BMD have been analyzed for each patient.
Results
Average values of FCI have been 0.42 for fractured femurs and 0.48 at the opposite side with a statistically significant difference (p = 0.002). Patients with severe hypovitaminosis D had a minor FCI compared to those with moderate deficiency (0.41 vs. 0.46, p < 0.011). 42 patients (27.6 %) with osteopenic or normal BMD have presented low values of FCI.
Discussion and conclusion
A significant correlation among low values of FCI, comorbidities, severe hypovitaminosis D. and BMD in patients with hip fractures has been found. FCI could be a useful tool to evaluate bone fragility and to predict fracture risk even in the normal and osteopenic BMD patients.
Similar content being viewed by others
References
Piscitelli P, Brandi ML, Tarantino U et al (2010) Incidence and socioeconomic burden of hip fractures in Italy: extension study 2003–2005. Reumatismo. 62:113–118
Reginster JY, Burlet N (2006) Osteoporosis: a still increasing prevalence. Bone 38:S4–S9
Tarantino U, Iundusi R, Cerocchi I et al (2011) Role of the orthopaedic in fragility fracture and in the prevention of a new fracture: SIOT 2009 recommendations. Aging Clin Exp Res. 23:25–27
Piscitelli P, Feola M, Rao C et al (2014) Ten years of hip fractures in Italy: for the first time a decreasing trend in elderly women. World J Orthop 5:386–391
Turner CH, Burr DB (1993) Basic biomechanical measurements of bone: a tutorial. Bone 14:595–608
Bell KL, Loveridge N, Power J et al (1999) Intracapsular hip fracture: increased cortical remodeling in the thinned and porous anterior region of the femoral neck. Osteoporos Int 10:248–257
Zebaze RM, Ghasem-Zadeh A, Bohte A et al (2010) Intracortical remodelling and porosity in the distal radius and post-mortem femurs of women: a crosssectional study. Lancet 375:1729–1736
Zebaze RM, Seeman E (2005) Cortical stability of the femoral neck and hip fracture risk. Lancet 366:1523
Petit MA, Paudel ML, Taylor BC et al (2010) Bone mass and strength in older men with type 2 diabetes: the osteoporotic fractures in men study. J Bone Miner Res 25:285–291
Leslie WD, Rubin MR, Schwartz AV et al (2012) Type 2 diabetes and bone. J Bone Miner Res 27:2231–2237
Holzer G, von Skrbensky G, Holzer LA et al (2009) Hip fractures and the contribution of cortical versus trabecular bone to femoral neck strength. J Bone Miner Res 24:468–474
Nickolas TL, Stein EM, Dworakowski E et al (2013) Rapid cortical bone loss in patients with chronic kidney disease. J Bone Miner Res 28:1811–1820
Nickolas TL, Stein E, Cohen A et al (2010) Bone mass and microarchitecture in CKD patients with fracture. J Am Soc Nephrol. 21:1371–1380
Singh M, Nagrath AR, Maini PS. (1970) Changes in trabecular pattern of the upper end of femur as an index of osteoporosis. J Bone Joint Surg Am. 52-A:457
Dorr LD, Faugere MC, Mackel AM et al (1993) Structural and cellular assessment of bone quality of proximal femur. Bone 14:231
Yeung Y, Chiu KY, Yau WP et al (2006) Assessment of the proximal femoral morphology using plain radiograph-can it predict the bone quality? J Arthroplasty 21:508–513
Baumgartner R, Heeren N, Quast D et al (2015) Is the cortical thickness index a valid parameter to assess bone mineral density in geriatric patients with hip fractures? Arch Orthop Trauma Surg 135:805–810
Adami S, Romagnoli E, Carnevale V et al (2011) Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS). Guidelines on prevention and treatment of vitamin D deficiency. Reumatismo 9 63:129–147
Report of a WHO Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organ Tech Rep Ser 843:1–129
Cerocchi I, Ghera S, Gasbarra E et al (2013) Fragility fractures: the clinical pathway. Aging Clin Exp Res. 25:S43–S45
Adami S, Romagnoli E, Carnevale V et al (2011) Guidelines on prevention and treatment of vitamin D deficiency. Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS). Reumatismo 9 63:129–147
Dorr LD (1986) Total hip replacement using APR system. Tech Orthop 1:22–34
Yeung Y, Chiu KY, Yau WP et al (2006) Assessment of the Proximal Femoral Morphology Using Plain Radiograph- Can it Predict the Bone Quality? J Arthroplasty 21:508–513
Ahlborg HG, Johnell O, Karlsson MK (2004) An age-related medullary expansion can have implications for the long-term fixation of hip prosthesis. Acta Orthop Scand 75:154
Celi M, Rao C, Scialdoni A et al (2013) Bone mineral density evaluation in osteoporosis: why yes and why not? Aging Clin Exp Res. 25:S47–S49
Ma L, Oei L, Jiang L et al (2012) Association between bone mineral density and type 2 diabetes mellitus: a meta-analysis of observational studies. Eur J Epidemiol 27:319–332
Yang S, Nguyen ND, Center JR et al (2014) Association between hypertension and fragility fracture: a longitudinal study. Osteoporos Int 25:97–103
Eckrich SG, Noble PC, Tullos HS (1994) Effect of rotation on the radiographic appearance of the femoral canal. J Arthroplasty 9:419–426
Eckrich SG, Noble PC, Tullos HS (1994) Effect of rotation on the radiographic appearance of the femoral canal. J Arthroplasty 9:419–426
Resmini G, Tarantino U, Iolascon G (2013) Vitamin D: role and opportunity to prescribe. Aging Clin Exp Res. 25:S125–S127
Martin EN, Haney EM, Shannon J et al (2015) Femoral volumetric bone density, geometry, and strength in relation to 25-hydroxy vitamin D in older men. J Bone Miner Res 30:562–569
Klotzbuecher CM, Ross PD, Landsman PB et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721
Nuti R, Brandi ML, Tarantino U et al (2009) New perspectives on the definition and the management of severe osteoporosis: the patient with two or more fragility fractures. J Endocrinol Invest 32:783–788
Springorum HR, Gebauer M, Mehrl A et al (2014) Fracture prevention by prophylactic femoroplasty of the proximal femur-metallic compared with cemented augmentation. J Orthop Trauma 28:403–409
Iolascon G, Resmini G, Tarantino U (2013) Effects of denosumab on cortical and trabecular microarchitecture: evidences from clinical studies. Aging Clin Exp Res. 25(Suppl 1):S19–S22
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/ or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
For this type of study formal consent is not required.
Rights and permissions
About this article
Cite this article
Feola, M., Rao, C., Tempesta, V. et al. Femoral cortical index: an indicator of poor bone quality in patient with hip fracture. Aging Clin Exp Res 27 (Suppl 1), 45–50 (2015). https://doi.org/10.1007/s40520-015-0423-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40520-015-0423-3