Osteoporosis International

, Volume 21, Issue 6, pp 919–929

Hip structural geometry and incidence of hip fracture in postmenopausal women: what does it add to conventional bone mineral density?

Original Article

DOI: 10.1007/s00198-009-1056-1

Cite this article as:
LaCroix, A.Z., Beck, T.J., Cauley, J.A. et al. Osteoporos Int (2010) 21: 919. doi:10.1007/s00198-009-1056-1



Hip geometry measurements of outer diameter and buckling ratio at the intertrochanter and shaft of the hip dual energy X-ray absorptiometry (DXA) scan predicted incident hip fracture in postmenopausal women. These associations, independent of age, body size, clinical risk factors, and conventional areal bone mineral density, suggest hip geometry plays a role in fracture etiology and may aid in improving identification of older women at high fracture risk.


This study examined whether hip geometry parameters predicted hip fracture independent of body size, clinical risk factors, and conventional femoral neck bone mineral density (aBMD) and whether summary factors could be identified to predict hip fracture.


We studied 10,290 postmenopausal women from the Women's Health Initiative. Eight thousand eight hundred forty-three remained fracture free during follow-up to 11 years of follow-up, while 147 fractured their hip, and 1,300 had other clinical fractures. Hip structural analysis software measured bone cross-sectional area, outer diameter, section modulus, average cortical thickness, and buckling ratio on archived DXA scans in three hip regions: narrow neck, intertrochanter, and shaft. Hazard ratios were estimated using Cox proportional hazards models for individual parameters and for composite factors extracted from principal components analysis from all 15 parameters.


After adjustment for age, body size, clinical risk factors, and aBMD, intertrochanter and shaft outer diameter measurements remained independent predictors of hip fracture with hazard ratios for a one standard deviation increase of 1.61 (95% confidence interval (CI), 1.25–2.08) for the intertrochanter and 1.36 (95% CI, 1.06–1.76) for the shaft. Average buckling ratios also independently predicted incident hip fracture with hazard ratios of 1.43 (95% CI, 1.10–1.87) at the intertrochanter and 1.24 (95% CI, 1.00–1.55) at the shaft. Although two composite factors were extracted from principal components analysis, neither was superior to these individual measurements at predicting incident hip fracture.


Two hip geometry parameters, intertrochanter outer diameter and buckling ratio, predict incident hip fracture after accounting for clinical risk factors and aBMD.


Bone density Bone strength Hip fracture Hip structural geometry Prospective studies 

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • A. Z. LaCroix
    • 1
    • 8
  • T. J. Beck
    • 2
  • J. A. Cauley
    • 3
  • C. E. Lewis
    • 4
  • T. Bassford
    • 5
  • R. Jackson
    • 6
  • G. Wu
    • 7
  • Z. Chen
    • 7
    • 9
  1. 1.WHI Clinical Coordinating CenterFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Department of RadiologyThe Johns Hopkins UniversityBaltimoreUSA
  3. 3.Department of EpidemiologyUniversity of PittsburghPittsburghUSA
  4. 4.Division of Preventive MedicineUniversity of AlabamaBirminghamUSA
  5. 5.Department of Family and Community MedicineUniversity of ArizonaTucsonUSA
  6. 6.Division of EndocrinologyOhio State UniversityColumbusUSA
  7. 7.Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonUSA
  8. 8.Fred Hutchinson Cancer Research CenterSeattleUSA
  9. 9.University of ArizonaTucsonUSA

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