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Extensive and Differential Deterioration of Hip Muscles May Preexist in Older Adults with Hip Fractures: Evidence from a Cross-Sectional Study

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Abstract

Hip muscles play an increasingly important role in lower limb function with aging. Investigating the deterioration of hip muscles and its relationship with hip fracture (HF) may help identify older adults prone to fall. In this study, patients with fall-related HF within 48 h and non-fracture controls aged ≥ 60 years were enrolled. The cross-sectional area (size) and attenuation (density) of the hip flexors, extensors, adductors, and abductors were calculated after segmentation on computed tomography images. The correlation of muscle parameters with HF and age were evaluated using logistic and multiple regression, respectively. Discrimination of HF was analyzed by receiver-operating characteristic analyses. A total of 220 patients and 91 controls were included. The size of the flexors, extensors, and abductors, and the density of the flexors, adductors, and abductors were lower in patients with HF after adjustment for sex, age, and body mass index (BMI). However, decreased muscle size was only observed in hip extensors in patients aged 60–74 years. Decreased muscle size was associated with HF independent of sex, age, BMI, and hip trabecular bone mineral density. Abductor size exhibited a significantly larger negative correlation with age in patients compared to controls. Including abductor size or all muscle size was effective for discrimination of HF in patients aged ≥ 75 years. In conclusion, older adults with HF may have sustained extensive and differential hip muscle deterioration before the injury; extensor atrophy in younger-old age and consideration of a closer relationship between abductor size and age deserve attention.

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Funding

This study was funded by National Key R&D Program of China (Grant No. 2020YFC2008700), Shanghai Clinical Research Center for Rehabilitation Medicine (Grant No. 21MC1930200), Science and Technology Commission of Shanghai Municipality (Grant No. 15411951500), and Foundation of Shanghai Municipal Commission of Health and Family Planning (Grant No. 2015ZB0501).

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  1. Ming Ling and Hou Huang have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China

    Ming Ling, Hou Huang, Xianlong Li, Yueyang Xu & Yongqian Fan

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  1. Ming Ling
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Contributions

ML and HH were responsible for data analysis, data interpretation, and manuscript preparation; and XL and YX for data acquisition and preprocessing; and YF for study design and manuscript revision.

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Correspondence to Yongqian Fan.

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Conflict of interest

Ming Ling, Hou Huang, Xianlong Li, Yueyang Xu, and Yongqian Fan have no competing interests to declare that are relevant to the content of this article.

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The study was approved by Ethical Committee of Huadong Hospital Affiliated to Fudan University. 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.

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Ling, M., Huang, H., Li, X. et al. Extensive and Differential Deterioration of Hip Muscles May Preexist in Older Adults with Hip Fractures: Evidence from a Cross-Sectional Study. Calcif Tissue Int 112, 328–337 (2023). https://doi.org/10.1007/s00223-022-01043-2

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