Prediction of incident hip fracture by femoral neck bone mineral density and neck–shaft angle: a 5-year longitudinal study in post-menopausal females

Abstract

Objective: To compare hip fracture incidence in post-menopausal females who were differently stratified for the fracture risk according to bone mineral density and proximal femur geometry. Methods: In a 5 year follow-up study, the hip fracture incidence in 729 postmenopausal females (45 of whom suffered from incident hip fracture) was assessed and compared. Forward logistic regression was used to select independent predictors of hip fracture risk, including age, age at menopause, height, weight, femoral neck bone mineral density (FNBMD), neck-shaft angle (NSA), hip axis length, femoral neck diameter and femoral shaft diameter as covariates. Fracture incidence was then calculated for the categories of young/old age, high/low FNBMD and wide/narrow NSA, which were obtained by dichotomising each hip fracture independent predictor at the value best separating females with and without a hip fracture. Results: The hip fracture incidence of the whole cohort was significantly higher in females with a wide NSA (8.52%) than in those with a narrow NSA (3.51%). The combination of wide NSA and low FNBMD had the highest hip fracture incidence in the whole cohort (17.61%) and each age category. The combinations of narrow/wide NSA with low/high FNBMD, respectively, gave a significantly higher fracture incidence in older than in younger women, whereas women with a combined wide NSA and low FNBMD had no significantly different fracture incidence in young (14.60%) or old age (21.62%). Conclusion: Our study showed that NSA is effective at predicting the hip fracture risk and that the detection in early post-menopause of a wide NSA together with a low FNBMD should identify females at high probability of incident hip fracture.

Type 1 diabetes patients have lower strength in femoral bone determined by quantitative computed tomography: A cross‐sectional study

“…The relationship of hip fractures with the hip axis length and neck-shaft angle measured by DXA scan has been investigated for years. A longer hip axis length9,18 and wider neck-shaft angle33 were found to be associated with hip fracture independently of BMD in postmenopausal women. Hip axis length and neck-shaft angle were comparable between patients with type 1 diabetes and controls in the present study (data not shown).…”

Three‐dimensional computed tomography reconstruction measurements of acetabulum in Chinese adults

“…The femoral neck shaft angle (NSA) has been reported to be an independent predictor of hip fracture risk (Alonso et al, ; Gnudi et al, ). In a United Kingdom (UK) population (Tuck et al, ), the NSA in the female was significantly smaller than in the male, which is inconsistent with those measured in the present study.…”

Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 1: Hip Geometry

“…All 3 of the longitudinal studies were BMD adjusted. The 2 studies with a follow-up of 5e10 yr found a small but significant association with an OR or HR per SD increase ranging from 1.11 to 1.15 (36,40). Although the 3rd study by Faulkner et al with 64 hip fractures ˃1.6 yr found no significant association: OR of 1.0 (95% CI 0.7e1.5) for FN fractures and 1.4 (95% CI 0.9e2.2) for trochanteric fractures, this was an early report of this cohort in 1993 (18).…”