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Published in: BMC Musculoskeletal Disorders 1/2024

Open Access 01-12-2024 | Osteoporosis | Research

Association of osteoporotic fractures of femoral neck and femoral neck geometric parameters in native Chinese women

Authors: Lin Li, Yi Shen, Li-Hua Tan, Hong Zhang, Ru-Chun Dai, Ling-Qing Yuan, Zhi-Feng Sheng, Xi-Yu Wu

Published in: BMC Musculoskeletal Disorders | Issue 1/2024

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Abstract

Background

Although it is generally believed that the femoral neck fracture is related to the femoral neck geometric parameters (FNGPs), the association between the risk of osteoporotic fracture of the femoral neck and FNGPs in native Chinese women is still unclear.

Methods

A total of 374 female patients (mean age 70.2 ± 9.32 years) with osteoporotic fracture of the femoral neck, and 374 non-fracture control groups were completely matched with the case group according to the age ratio of 1:1. Using DXA bone densitometer to measured eight FNGPs: the outer diameter (OD), cross-sectional area (CSA), cortical thickness (CT), endocortical diameter (ED), buckling ratio (BR), section modulus (SM), cross-sectional moment of inertia (CSMI), and compressive strength index (CSI) at the narrowest point of the femoral neck.

Results

Compared with the control group, the average values of OD (2.9%), ED (4.5%), and BR (26.1%) in the patient group significantly increased (p = 0.015 to < 0.001), while CSA (‒15.3%), CT (‒18.2%), SM (‒10.3%), CSMI (‒6.4%), and CSI (‒10.8%) significantly decreased (all p < 0.001). The prevalence of osteoporosis in the lumbar spine, femoral neck, and total hip was, respectively, 82%, 81%, and 65% in fracture patients. Cox proportional hazard model analysis showed that in the age adjusted model, the fracture hazard ratio (HR) of CSA, CT, BR, SM, and CSI significantly increased (HRs = 1.60‒8.33; 95% CI = 1.08‒16.6; all p < 0.001). In the model adjusted for age and femoral neck BMD, HRs of CT (HRs = 3.90‒8.03; 95% CI = 2.45‒15.1; all p < 0.001) and BR (HRs = 1.62‒2.60; 95% CI = 1.20‒5.44; all p < 0.001) were still significantly increased.

Conclusion

These results suggest that the majority of osteoporotic fractures of the femoral neck of native Chinese women occur in patients with osteoporosis. CT thinning or BR increase of FNGPs may be independent predictors of fragility fracture of femoral neck in native Chinese women unrelated to BMD.
Literature
1.
go back to reference Cheng ZA, Lin DK, Liu DB, Shen HY, Chen Q, Qiu QW, et al. A 10-year-review (1998–2007) on 3449 cases of osteoporotic hip fractures: trend of hospitalization and inpatient costs. Chin J Epidemiol (Chinese). 2008;29:1128–31. Cheng ZA, Lin DK, Liu DB, Shen HY, Chen Q, Qiu QW, et al. A 10-year-review (1998–2007) on 3449 cases of osteoporotic hip fractures: trend of hospitalization and inpatient costs. Chin J Epidemiol (Chinese). 2008;29:1128–31.
2.
go back to reference Tan WL, Low SL, Shen L, Das De S. Osteoporotic hip fractures: 10-year review in a Singaporean hospital. J Orthop Surg (Hong Kong). 2015;23:150–4.PubMedCrossRef Tan WL, Low SL, Shen L, Das De S. Osteoporotic hip fractures: 10-year review in a Singaporean hospital. J Orthop Surg (Hong Kong). 2015;23:150–4.PubMedCrossRef
3.
go back to reference Thorngren KG, Hommel A, Norrman PO, Thorngren J, Wingstrand H. Epidemiology of femoral neck fractures. Injury. 2002;33(suppl 3):C1–7.PubMedCrossRef Thorngren KG, Hommel A, Norrman PO, Thorngren J, Wingstrand H. Epidemiology of femoral neck fractures. Injury. 2002;33(suppl 3):C1–7.PubMedCrossRef
4.
5.
go back to reference Al-Ani AN, Samuelsson B, Tidermark J, Norling A, Ekström W, Cederholm T, et al. Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg Am. 2008;90:1436–42.PubMedCrossRef Al-Ani AN, Samuelsson B, Tidermark J, Norling A, Ekström W, Cederholm T, et al. Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg Am. 2008;90:1436–42.PubMedCrossRef
6.
go back to reference Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23:2239–56.PubMedPubMedCentralCrossRef Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23:2239–56.PubMedPubMedCentralCrossRef
8.
go back to reference Yao P, Parish S, Bennett DA, Du H, Yang L, Chen Y, et al. Gender differences in modifiable risk factors for hip fracture: 10-year follow-up of a prospective study of 0.5 million Chinese adults. J Intern Med. 2022;291:481–92.PubMedCrossRef Yao P, Parish S, Bennett DA, Du H, Yang L, Chen Y, et al. Gender differences in modifiable risk factors for hip fracture: 10-year follow-up of a prospective study of 0.5 million Chinese adults. J Intern Med. 2022;291:481–92.PubMedCrossRef
9.
go back to reference Xia WB, He SL, Xu L, Liu AM, Jiang Y, Li M, et al. Rapidly increasing rates of hip fracture in Beijing, China. J Bone Min Res. 2012;27:125–9.CrossRef Xia WB, He SL, Xu L, Liu AM, Jiang Y, Li M, et al. Rapidly increasing rates of hip fracture in Beijing, China. J Bone Min Res. 2012;27:125–9.CrossRef
10.
go back to reference Chie WC, Yang RS, Liu JP, Tsai KS. High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Osteoporos Int. 2004;15:998–1002.PubMedCrossRef Chie WC, Yang RS, Liu JP, Tsai KS. High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Osteoporos Int. 2004;15:998–1002.PubMedCrossRef
11.
go back to reference Cheng SY, Levy AR, Lefaivre KA, Guy P, Kuramoto L, Sobolev B. Geographic trends in incidence of hip fractures: a comprehensive literature review. Osteoporos Int. 2011;22:2575–86.PubMedCrossRef Cheng SY, Levy AR, Lefaivre KA, Guy P, Kuramoto L, Sobolev B. Geographic trends in incidence of hip fractures: a comprehensive literature review. Osteoporos Int. 2011;22:2575–86.PubMedCrossRef
12.
go back to reference Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochberg MC, et al. Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA. 2005;293:2102–8.PubMedCrossRef Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochberg MC, et al. Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA. 2005;293:2102–8.PubMedCrossRef
13.
go back to reference Nelson DA, Beck TJ, Wu G, Lewis CE, Bassford T, Cauley JA, et al. Ethnic differences in femur geometry in the women’s health initiative observational study. Osteoporos Int. 2011;22:1377–88.PubMedCrossRef Nelson DA, Beck TJ, Wu G, Lewis CE, Bassford T, Cauley JA, et al. Ethnic differences in femur geometry in the women’s health initiative observational study. Osteoporos Int. 2011;22:1377–88.PubMedCrossRef
14.
go back to reference Leslie WD, O’Donnell S, Lagacé C, Walsh P, Bancej C, Jean S, et al. Population-based Canadian hip fracture rates with international comparisons. Osteoporos Int. 2010;21:1317–22.PubMedCrossRef Leslie WD, O’Donnell S, Lagacé C, Walsh P, Bancej C, Jean S, et al. Population-based Canadian hip fracture rates with international comparisons. Osteoporos Int. 2010;21:1317–22.PubMedCrossRef
15.
go back to reference Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Min Res. 2003;18:1947–54.CrossRef Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Min Res. 2003;18:1947–54.CrossRef
16.
17.
go back to reference Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004;34:195–202.PubMedCrossRef Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004;34:195–202.PubMedCrossRef
19.
go back to reference Leslie WD, Pahlavan PS, Tsang JF, Lix LM. Manitoba bone density program. Prediction of hip and other osteoporotic fractures from hip geometry in a large clinical cohort. Osteoporos Int. 2009;20:1767–74.PubMedCrossRef Leslie WD, Pahlavan PS, Tsang JF, Lix LM. Manitoba bone density program. Prediction of hip and other osteoporotic fractures from hip geometry in a large clinical cohort. Osteoporos Int. 2009;20:1767–74.PubMedCrossRef
20.
21.
22.
go back to reference Njeh CF, Fuerst T, Hans D, Blake GM, Genant HK. Radiation exposure in bone mineral density assessment. Appl Radiat Isot. 1999;50:215–36.PubMedCrossRef Njeh CF, Fuerst T, Hans D, Blake GM, Genant HK. Radiation exposure in bone mineral density assessment. Appl Radiat Isot. 1999;50:215–36.PubMedCrossRef
23.
go back to reference Danielso ME, Beck TJ, Karlamangla AS, Greendale GA, Atkinson EJ, Lian Y, et al. A comparison of DXA and CT based methods for estimating the strength of the femoral neck in post-menopausal women. Osteoporos Int. 2013;24:1379–88.CrossRef Danielso ME, Beck TJ, Karlamangla AS, Greendale GA, Atkinson EJ, Lian Y, et al. A comparison of DXA and CT based methods for estimating the strength of the femoral neck in post-menopausal women. Osteoporos Int. 2013;24:1379–88.CrossRef
24.
go back to reference Clotet J, Martelli Y, Di Gregorio S, Del Río Barquero LM, Humbert L. Structural parameters of the proximal femur by 3-Dimensional Dual-Energy X-ray Absorptiometry Software: comparison with quantitative computed tomography. J Clin Densitom. 2018;21:550–62.PubMedCrossRef Clotet J, Martelli Y, Di Gregorio S, Del Río Barquero LM, Humbert L. Structural parameters of the proximal femur by 3-Dimensional Dual-Energy X-ray Absorptiometry Software: comparison with quantitative computed tomography. J Clin Densitom. 2018;21:550–62.PubMedCrossRef
25.
go back to reference Shen Y, Tang ML, Wu XP, Yuan LQ, Dai RC, Zhang H, et al. Gender differences in a reference database of age-related femoral neck geometric parameters for Chinese population and their association with femoral neck fractures. Bone. 2016;93:64–70.PubMedCrossRef Shen Y, Tang ML, Wu XP, Yuan LQ, Dai RC, Zhang H, et al. Gender differences in a reference database of age-related femoral neck geometric parameters for Chinese population and their association with femoral neck fractures. Bone. 2016;93:64–70.PubMedCrossRef
26.
go back to reference Wu XP, Liao EY, Zhang H, Shan PF, Cao XZ, Liu SP. Establishment of BMD reference plots and determination of peak BMD at multiple skeletal regions in mainland Chinese women and the diagnosis of osteoporosis. Osteoporos Int. 2004;15:71–9.PubMedCrossRef Wu XP, Liao EY, Zhang H, Shan PF, Cao XZ, Liu SP. Establishment of BMD reference plots and determination of peak BMD at multiple skeletal regions in mainland Chinese women and the diagnosis of osteoporosis. Osteoporos Int. 2004;15:71–9.PubMedCrossRef
27.
go back to reference Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd. Khaltaev N. A reference standard for the description of osteoporosis. Bone. 2008;42:467–75.PubMedCrossRef Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd. Khaltaev N. A reference standard for the description of osteoporosis. Bone. 2008;42:467–75.PubMedCrossRef
28.
go back to reference Duan Y, Beck TJ, Wang XF, Seeman E. Structural and biomechanical basis of sexual dimorphism in femoral neck fragility has its origins in growth and aging. J Bone Min Res. 2003;18:1766–74.CrossRef Duan Y, Beck TJ, Wang XF, Seeman E. Structural and biomechanical basis of sexual dimorphism in femoral neck fragility has its origins in growth and aging. J Bone Min Res. 2003;18:1766–74.CrossRef
29.
go back to reference Karlamangla AS, Barrett-Connor E, Young J, Greendale GA. Hip fracture risk assessment using composite indices of femoral neck strength: the Rancho Bernardo study. Osteoporos Int. 2004;15:62–70.PubMedCrossRef Karlamangla AS, Barrett-Connor E, Young J, Greendale GA. Hip fracture risk assessment using composite indices of femoral neck strength: the Rancho Bernardo study. Osteoporos Int. 2004;15:62–70.PubMedCrossRef
30.
31.
go back to reference Pasco JA, Seeman E, Henry MJ, Merriman EN, Nicholson GC, Kotowicz MA. The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int. 2006;17:1404–9.PubMedCrossRef Pasco JA, Seeman E, Henry MJ, Merriman EN, Nicholson GC, Kotowicz MA. The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int. 2006;17:1404–9.PubMedCrossRef
32.
go back to reference Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004;164:1108–12.PubMedCrossRef Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004;164:1108–12.PubMedCrossRef
33.
go back to reference Wainwright SA, Marshall LM, Ensrud KE, Cauley JA, Black DM, Hillier TA, et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. 2005;90:2787–93.PubMedCrossRef Wainwright SA, Marshall LM, Ensrud KE, Cauley JA, Black DM, Hillier TA, et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. 2005;90:2787–93.PubMedCrossRef
34.
go back to reference Rogmark C, Kristensen MT, Viberg B, Rönnquist SS, Overgaard S, Palm H. Hip fractures in the non-elderly-who, why and whither? Injury. 2018;49:1445–50.PubMedCrossRef Rogmark C, Kristensen MT, Viberg B, Rönnquist SS, Overgaard S, Palm H. Hip fractures in the non-elderly-who, why and whither? Injury. 2018;49:1445–50.PubMedCrossRef
35.
go back to reference Thoors O, Mellner C, Hedström M. Good clinical outcome for the majority of younger patients with hip fractures: a Swedish nationwide study on 905 patients younger than 50 years of age. Acta Orthop. 2021;92:292–6.PubMedPubMedCentralCrossRef Thoors O, Mellner C, Hedström M. Good clinical outcome for the majority of younger patients with hip fractures: a Swedish nationwide study on 905 patients younger than 50 years of age. Acta Orthop. 2021;92:292–6.PubMedPubMedCentralCrossRef
36.
go back to reference Iolascon G, Moretti A, Cannaviello G, Resmini G, Gimigliano F. Proximal femur geometry assessed by hip structural analysis in hip fracture in women. Aging Clin Exp Res. 2015;27(Suppl 1):S17–21.PubMedCrossRef Iolascon G, Moretti A, Cannaviello G, Resmini G, Gimigliano F. Proximal femur geometry assessed by hip structural analysis in hip fracture in women. Aging Clin Exp Res. 2015;27(Suppl 1):S17–21.PubMedCrossRef
37.
go back to reference Riggs BL, Melton Iii LJ 3rd, Robb RA, Camp JJ, Atkinson EJ, Peterson JM, et al. Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites. J Bone Min Res. 2004;19:1945–54.CrossRef Riggs BL, Melton Iii LJ 3rd, Robb RA, Camp JJ, Atkinson EJ, Peterson JM, et al. Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites. J Bone Min Res. 2004;19:1945–54.CrossRef
38.
go back to reference Szulc P, Duboeuf F, Schott AM, Dargent-Molina P, Meunier PJ, Delmas PD. Structural determinants of hip fracture in elderly women: re-analysis of the data from the EPIDOS study. Osteoporos Int. 2006;17:231–6.PubMedCrossRef Szulc P, Duboeuf F, Schott AM, Dargent-Molina P, Meunier PJ, Delmas PD. Structural determinants of hip fracture in elderly women: re-analysis of the data from the EPIDOS study. Osteoporos Int. 2006;17:231–6.PubMedCrossRef
39.
go back to reference Maeda Y, Sugano N, Saito M, Yonenobu K. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures. Clin Orthop Relat Res. 2011;469:884–9.PubMedCrossRef Maeda Y, Sugano N, Saito M, Yonenobu K. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures. Clin Orthop Relat Res. 2011;469:884–9.PubMedCrossRef
40.
go back to reference Nyholm AM, Palm H, Sandholdt H, Troelsen A, Gromov K, DFDB COLLABORATORS. Risk of reoperation within 12 months following osteosynthesis of a displaced femoral neck fracture is linked mainly to initial fracture displacement while risk of death may be linked to bone quality: a cohort study from Danish fracture database. Acta Orthop. 2020;91:1–75.PubMedCrossRef Nyholm AM, Palm H, Sandholdt H, Troelsen A, Gromov K, DFDB COLLABORATORS. Risk of reoperation within 12 months following osteosynthesis of a displaced femoral neck fracture is linked mainly to initial fracture displacement while risk of death may be linked to bone quality: a cohort study from Danish fracture database. Acta Orthop. 2020;91:1–75.PubMedCrossRef
41.
go back to reference Iolascon G, Paoletta M, Liguori S, Gimigliano F, Moretti A. Bone fragility: conceptual framework, therapeutic implications, and COVID-19-related issues. Ther Adv Musculoskelet Dis. 2022;14:1759720X221133429.PubMedPubMedCentralCrossRef Iolascon G, Paoletta M, Liguori S, Gimigliano F, Moretti A. Bone fragility: conceptual framework, therapeutic implications, and COVID-19-related issues. Ther Adv Musculoskelet Dis. 2022;14:1759720X221133429.PubMedPubMedCentralCrossRef
42.
go back to reference Zhang F, Tan LJ, Lei SF, Deng HW. The differences of femoral neck geometric parameters: effects of age, gender and race. Osteoporos Int. 2010;21:1205–14.PubMedCrossRef Zhang F, Tan LJ, Lei SF, Deng HW. The differences of femoral neck geometric parameters: effects of age, gender and race. Osteoporos Int. 2010;21:1205–14.PubMedCrossRef
43.
go back to reference Iki M, DongMei N, Tamaki J, Sato Y, Kagamimori S, Kagawa Y, et al. Age-specific reference values of hip geometric indices from a representative sample of the Japanese female population: Japanese Population-based osteoporosis (JPOS) study. Osteoporos Int. 2011;22:1987–96.PubMedCrossRef Iki M, DongMei N, Tamaki J, Sato Y, Kagamimori S, Kagawa Y, et al. Age-specific reference values of hip geometric indices from a representative sample of the Japanese female population: Japanese Population-based osteoporosis (JPOS) study. Osteoporos Int. 2011;22:1987–96.PubMedCrossRef
44.
go back to reference Khoo BC, Brown K, Zhu K, Pollock M, Wilson KE, Price RI, et al. Differences in structural geometrical outcomes at the neck of the proximal femur using two-dimensional DXA-derived projection (APEX) and three-dimensional QCT-derived (BIT QCT) techniques. Osteoporos Int. 2012;23:1393–8.PubMedCrossRef Khoo BC, Brown K, Zhu K, Pollock M, Wilson KE, Price RI, et al. Differences in structural geometrical outcomes at the neck of the proximal femur using two-dimensional DXA-derived projection (APEX) and three-dimensional QCT-derived (BIT QCT) techniques. Osteoporos Int. 2012;23:1393–8.PubMedCrossRef
Metadata
Title
Association of osteoporotic fractures of femoral neck and femoral neck geometric parameters in native Chinese women
Authors
Lin Li
Yi Shen
Li-Hua Tan
Hong Zhang
Ru-Chun Dai
Ling-Qing Yuan
Zhi-Feng Sheng
Xi-Yu Wu
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2024
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-024-07483-1

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