Journal
JOURNAL OF BONE AND MINERAL RESEARCH
Volume 23, Issue 8, Pages 1326-1333Publisher
WILEY-BLACKWELL
DOI: 10.1359/JBMR.080316
Keywords
men; hip fracture; hip structure; osteoporosis; BMD
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Funding
- NCRR NIH HHS [UL1 RR024140] Funding Source: Medline
- NIAMS NIH HHS [U01 AR066160, U01 AR045580, U01 AR045632, UO1 AR45647, UO1 AR45654, UO1 AR45632, UO1 AR45583, U01 AR045647, UO1 AR45614, UO1 AR45580, U01 AR045583, U01 AR045654, U01 AR045614] Funding Source: Medline
- NIA NIH HHS [U01 AG042140, U01 AG027810, UO1 AG18197, U01 AG018197] Funding Source: Medline
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The structure of the femoral neck contributes to hip strength, but the relationship of specific structural features of the hip to hip fracture risk is unclear. The objective of this study is to determine the contribution of structural features and volumetric density of both trabecular and cortical bone in the proximal femur to the prediction of hip fracture in older men. Baseline QCT scans of the hip were obtained in 3347 men; >= 65 yr of age enrolled in the Osteoporotic Fractures in Men Study (MrOS). All men were followed prospectively for an average of 5.5 yr. Areal BMD (aBMD) by DXA was also assessed. We determined the associations between QCT-derived measures of femoral neck structure, Volumetric bone density, and hip fracture risk. Forty-two men sustained incident hip fractures during follow-up: an overall rate of 2.3/1000 person-years. Multivariable analyses showed that, among the QCT-derived measures, lower percent cortical volume (hazard ratio [HR] per SD decrease: 3.2; 95% CI: 2.2-4.6), smaller minimal cross-sectional area (HR: 1.6; 95% CI: 1.2-2.1), and lower trabecular BMD (HR: 1.7; 95% CI: 1.2-2.4) were independently related to increased hip fracture risk. Femoral neck areal BMD was also strongly related to hip fracture risk (HR: 4.1; 95% CI: 2.7-6.4). In multivariable models, percent cortical volume and minimum cross-sectional area remained significant predictors of hip fracture risk after adjustment for areal BMD, but overall prediction was not improved by adding QCT parameters to DXA. Specific structural features of the proximal femur were related to an increased risk of hip fracture. Whereas overall hip fracture prediction was not improved relative to aBMD, by adding QCT parameters, these results yield useful information concerning the causation of hip fracture, the evaluation of hip fracture risk, and potential targets for therapeutic intervention.
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