Interpretation of hip fracture patterns using areal bone mineral density in the proximal femur
Interpretation of hip fracture patterns using areal bone mineral density in the proximal femur
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DOI：
10.1007/s00402-015-2326-3
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发表时间：
2015-12-01
影响因子：
2.3
通讯作者：
Kagda, Fareed H. Y.
中科院分区：
文献类型：
--
作者：
Hey, Hwee Weng Dennis;Sng, Weizhong Jonathan;Kagda, Fareed H. Y.
介绍骨密度扫描目前解释的基础上，整个股骨近端的平均得分。技术的进步使我们能够测量股骨近端特定区域的骨密度。本研究试图通过将区域BMD（aBMD）评分与骨折模式相关联来解释股骨颈（NOF）和转子间/基底颈（IT）骨折的病理生理学，并探讨这些骨折模式的可能预测因素。共研究了106例患者（44例IT/基底颈椎骨折，62例NOF骨折）。检索的数据包括患者特征和损伤后1个月内在对侧髋关节不同区域测量的aBMD评分。使用Fisher精确检验和双样本t检验分析IT和NOF骨折之间的人口统计学和临床特征差异。采用多变量回归模型评估aBMD评分与骨折类型之间的关系，经调整的多变量分析后，股骨粗隆间/颈下骨折的T-Troc和T-inter评分显著低于股骨颈骨折（分别为P = 0.022和P = 0.026）。未发现股骨转子间/基底颈骨折（平均T.Tot -1.99）和股骨颈骨折（平均T.Tot -1.64）与平均T.tot小于-2.5相关。然而，股骨粗隆间/颈下骨折和股骨颈骨折的平均aBMD评分始终低于-2.5。性别和受伤时钙摄入量与特定髋部骨折模式相关（分别为P = 0.002和P = 0.011）。低能量创伤后髋部骨折模式可能受到髋部不同区域骨密度降低模式的影响。与股骨颈骨折相比，股骨转子间/基底颈骨折的T-Troc和T-Inter评分显著较低，表明骨折穿过股骨近端骨密度最低的区域。在T.Troc和T.Inter未复位的情况下，股骨颈骨折更常见。总T评分可能低估骨质疏松/骨量减少的严重程度，测量股骨颈的T评分可能更好地反映骨质疏松的严重程度和脆性骨折的可能性。
Introduction Bone mineral density scans are currently interpreted based on an average score of the entire proximal femur. Improvements in technology now allow us to measure bone density in specific regions of the proximal femur. The study attempts to explain the pathophysiology of neck of femur (NOF) and intertrochanteric/basi-cervical (IT) fractures by correlating areal BMD (aBMD) scores with fracture patterns, and explore possible predictors for these fracture patterns.This is a single institution retrospective study on all patients who underwent hip surgeries from June 2010 to August 2012. A total of 106 patients (44 IT/basi-cervical, 62 NOF fractures) were studied. The data retrieved include patient characteristics and aBMD scores measured at different regions of the contralateral hip within 1 month of the injury. Demographic and clinical characteristic differences between IT and NOF fractures were analyzed using Fisher's Exact test and two-sample t test. Relationship between aBMD scores and fracture patterns was assessed using multivariable regression modeling.After adjusted multivariable analysis, T-Troc and T-inter scores were significantly lower in intertrochanteric/basi-cervical fractures compared to neck of femur fractures (P = 0.022 and P = 0.026, respectively). Both intertrochanteric/basi-cervical fractures (mean T.Tot -1.99) and neck of femur fractures (mean T.Tot -1.64) were not found to be associated with a mean T.tot less than -2.5. However, the mean aBMD scores were consistently less than -2.5 for both intertrochanteric/basi-cervical fractures and neck of femur fractures. Gender and calcium intake at the time of injury were associated with specific hip fracture patterns (P = 0.002 and P = 0.011, respectively).Hip fracture patterns following low energy trauma may be influenced by the pattern of reduced bone density in different areas of the hip. Intertrochanteric/basi-cervical fractures were associated with significantly lower T-Troc and T-Inter scores compared to neck of femur fractures, suggesting that the fracture traversed through the areas with the lowest bone density in the proximal femur. In the absence of reduced T.Troc and T.Inter, neck of femur fractures occurred more commonly. T-Total scores may underestimate the severity of osteoporosis/osteopenia and measuring T-score at the neck of femur may better reflect the severity of osteoporosis and likelihood of a fragility fracture.