Skip to main content
SpringerLink
Log in

Anatomical factors associated with femoral neck fractures of elderly Beijing women

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

Analyses using newly developed structural measures of minimal model (aBMD, W, Sigma, Delta) in a Chinese female age-matched cohort of femoral neck fracture patients and non-fracture community controls resulted in improved fracture prediction, suggesting the usefulness of new variables, extending the value of widely available DXA technology.

Introduction

We have developed a new approach to evaluate 2D femoral neck (FN) structure, the minimal model (MM). This model includes FNaBMD and FNWidth with two new internal structural measures, the standard deviation of normalized mineral mass projection profile distribution (FNSigma) and the displacement between center of mineral (CoM) mass and geometric center of mineral mass projection profile (FNDelta).

Methods

Differences in these four structural measurements together with age, weight, and height were compared in the contralateral hip of 285 FN fracture Chinese female patients and 261 age-matched community controls. Structural variables were calculated from DXA equivalent 2D images obtained from QCT scans analyzed using Mindways Software.

Results

Review of FN scanned profiles of fracture patients and controls identified substantial reduction in mineral mass in the superior segment of FN. Fracture participants were taller, weighed less, and had lower FNaBMD and larger FNDelta, due to a larger inferior displacement in the CoM, consistent with greater reduction in superior segment bone. Logistic regression identified increased height, reduced FNaBMD, increased FNDelta, and reduced FNSigma per SD as significant independent contributors to differentiating fracture from non-fracture. Area under ROC analysis identified significant improvement in discrimination with the addition of FNDelta and FNSigma to the model including age, height, weight, and FNaBMD (C statistic 0.87 and 0.84 respectively).

Conclusions

These data extend previous data that identified the benefit of 2D FN internal structural information in discriminating those at increased future fracture risk from recently fractured individuals. These data support continuing investigation of MM analysis as a straightforward analytical approach adding value to DXA hip aBMD in predicting fracture risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50(10):1644–1650

    Article  Google Scholar 

  2. Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS, Hebel JR (1997) Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health 87(10):1630–1636

    Article  CAS  Google Scholar 

  3. Cree M, Soskolne CL, Belseck E, Hornig J, McElhaney JE, Brant R, Suarez-Almazor M (2000) Mortality and institutionalization following hip fracture. J Am Geriatr Soc 48(3):283–288

    Article  CAS  Google Scholar 

  4. Cummings SR, Nevitt MC, Browner WS et al (1995) Risk factors for hip fracture in white women: The Study of Osteoporotic Fractures Research Group. N Engl J Med 332(12):767–774

    Article  CAS  Google Scholar 

  5. Brown JP, Prince RL, Deal C, Recker RR, Kiel DP, de Gregorio LH, Hadji P, Hofbauer LC, Álvaro-Gracia JM, Wang H, Austin M, Wagman RB, Newmark R, Libanati C, San Martin J, Bone HG (2009) Comparison of the effect of denosumab and alendronate on BMD and biochemical markers of bone turnover in postmenopausal women with low bone mass: a randomized, blinded, phase 3 trial. J Bone Miner Res 24(1):153–161

    Article  CAS  Google Scholar 

  6. Khoo BCC, Brown K, Lewis JR, Perilli E, Prince RL (2019) Ageing effects on 3-dimensional femoral neck cross-sectional asymmetry: implications for age-related bone fragility in falling. J Clin Densitom 22(2):153–161

    Article  CAS  Google Scholar 

  7. Rudman KE, Aspden RM, Meakin JR (2006) Compression or tension? The stress distribution in the proximal femur. Biomed Eng Online 5:12

    Article  CAS  Google Scholar 

  8. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285(6):785–795

    Article  Google Scholar 

  9. Beck TJ, Ruff CB, Warden KE, Scott WW Jr, Rao GU (1990) Predicting femoral neck strength from bone mineral data. A structural approach. Investig Radiol 25(1):6–18

    Article  CAS  Google Scholar 

  10. Duboeuf F, Hans D, Schott AM, Kotzki PO, Favier F, Marcelli C, Meunier PJ, Delmas PD (1997) Different morphometric and densitometric parameters predict cervical and trochanteric hip fracture: the EPIDOS study. J Bone Miner Res 12(11):1895–1902

    Article  CAS  Google Scholar 

  11. Kaptoge S, Dalzell N, Loveridge N, Beck TJ, Khaw KT, Reeve J (2003) Effects of gender, anthropometric variables, and aging on the evolution of hip strength in men and women aged over 65. Bone. 32:561–570

    Article  Google Scholar 

  12. Khoo BC, Beck TJ, Qiao QH et al (2005) In vivo short-term precision of hip structure analysis variables in comparison with bone mineral density using paired dual-energy X-ray absorptiometry scans from multi-centre clinical trials. Bone. 37(1):112–121

    Article  Google Scholar 

  13. Poole KE, Mayhew PM, Rose CM et al (2010) Changing structure of the femoral neck across the adult female lifespan. J Bone Miner Res 25(3):482–491

    Article  Google Scholar 

  14. Khoo BC, Brown K, Zhu K, Price RI, Prince RL (2014) Effects of the assessment of 4 determinants of structural geometry on QCT- and DXA-derived hip structural analysis measurements in elderly women. J Clin Densitom 17(1):38–46

    Article  Google Scholar 

  15. Khoo BC, Lewis JR, Brown K, Prince RL (2016) Evaluation of a simplified hip structure analysis method for the prediction of incident hip fracture events. Osteoporos Int 27(1):241–248

    Article  CAS  Google Scholar 

  16. Khoo BCC, Brown K, Cann C et al (2009) Comparison of QCT-derived and DXA-derived areal bone mineral density (aBMD) and T-scores. Osteoporos Int 20(9):1539–1545

    Article  CAS  Google Scholar 

  17. Khoo BCC, Brown K, Zhu K et al (2012) 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 23(4):1393–1398

    Article  CAS  Google Scholar 

  18. Su YB, Wang L, Wu XB, Yi C, Yang MH, Yan D, Cheng KB, Cheng XG (2019) The spatial differences in bone mineral density and hip structure between low-energy femoral neck and trochanteric fractures in elderly Chinese using quantitative computed tomography. Bone. 124:62–68

    Article  Google Scholar 

  19. Wang L, Museyko O, Su Y, Brown K, Yang R, Zhang Y, Duanmu Y, Guo Z, Zhang W, Yan D, Cheng X, Engelke K (2019) QCT of the femur: comparison between QCTPro CTXA and MIAF femur. Bone 120:262–270

    Article  Google Scholar 

  20. Wang L, Khoo BCC, Cheng XG, Brown K, Lewis JR, Su YB, Guo Z, Li K, Prince RL (2017) Differences in femoral neck structure between elderly Caucasian and Chinese populations: a cross-sectional study of Perth-Beijing cohorts. Arch Osteoporos 12(1):72

    Article  CAS  Google Scholar 

  21. Zukerman JD (1996) Hip fracture. N Engl J Med 334(23):1519–1525

    Article  Google Scholar 

  22. Johannesdottir F, Poole KES, Reeve J, Siggeirsdottir K, Aspelund T, Mogensen B, Jonsson BY, Sigurdsson S, Harris TB, Gudnason VG, Sigurdsson G (2011) Distribution of cortical bone in the femoral neck and hip fracture: a prospective case-control analysis of 143 incident hip fractures; the AGES-REYKJAVIK study. Bone. 48(6):1268–1276

    Article  Google Scholar 

  23. Mayhew PM, Thomas CD, Clement JG et al (2005) Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet 366:129–135

    Article  Google Scholar 

  24. Uusi-Rasi K, Semanick LM, Zanchetta JR et al (2005) Effects of teriparatide [rhPTH (1–34)] treatment on structural geometry of the proximal femur in elderly osteoporotic women. Bone 36:948–958

    Article  CAS  Google Scholar 

  25. Greenspan SL, Beck TJ, Resnick NM, Bhattacharya R, Parker RA (2005) Effect of hormone replacement, alendronate, or combination therapy on hip structural geometry: a 3-year, double-blind, placebo-controlled clinical trial. J Bone Miner Res 20(9):1525–1532

    Article  CAS  Google Scholar 

  26. Petit MA, McKay HA, KJ MK et al (2002) A randomized school-based jumping intervention confers site and maturity-specific benefits on bone structural properties in girls: a hip structural analysis study. J Bone Miner Res 17(3):363–372

    Article  CAS  Google Scholar 

  27. Kaptoge S, Beck TJ, Reeve J et al (2008) Prediction of incident hip fracture risk by femur geometry variables measured by hip structural analysis in the study of osteoporotic fractures. J Bone Miner Res 23(12):1892–1904

    Article  Google Scholar 

  28. Faulkner KG, Genant HK, McClung M (1995) Bilateral comparison of femoral bone density and hip axis length from single and fan beam DXA scans. Calcif Tissue Int 56(1):26–31

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Benjamin Cheng Choon Khoo

  2. School of Biomedical Sciences, University of Western Australia, Nedlands, WA, Australia

    Benjamin Cheng Choon Khoo

  3. Department of Radiology, Beijing Jishuitan Hospital, Beijing, China

    Ling Wang & Xiaoguang Cheng

  4. School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

    Joshua Richard Lewis

  5. Medical School, University of Western Australia, Nedlands, Australia

    Joshua Richard Lewis & Richard Lewis Prince

  6. Mindways Software, Austin, TX, USA

    Keenan Brown

  7. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Richard Lewis Prince

Authors
  1. Benjamin Cheng Choon Khoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ling Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joshua Richard Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keenan Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaoguang Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Richard Lewis Prince
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin Cheng Choon Khoo.

Ethics declarations

Institutional Review Board (IRB) was obtained from the ethics committee of Beijing Jishuitan Hospital with informed consent obtained.

Conflict of interest

K Brown is a stockholder of Mindways Software Inc. BCC Khoo, L Wang, JR Lewis, XG Cheng, and RL Prince declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Benjamin CC Khoo and Ling Wang are first equal authors

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khoo, B.C.C., Wang, L., Lewis, J.R. et al. Anatomical factors associated with femoral neck fractures of elderly Beijing women. Arch Osteoporos 15, 112 (2020). https://doi.org/10.1007/s11657-020-00780-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-020-00780-x

Keywords

Search

Navigation