Relationship Between Hip Geometry,Community Fall Risk Assessment And Osteoporotic Hip Fracture In The Elderly

Osteoporosis is a serious health problem in the elderly,which is characterized by low bone mineral density(BMD)and destruction of microstructures,resulting in an increased risk of osteoporotic fractures.Osteoporosis fracture is the most serious clinical consequence of osteoporosis in the elderly.Hip bone mineral density has been used as an effective clinical predictor of hip fracture.Bone geometry is also considered as another important predictor of fracture,which is independent of bone mineral density and can determine bone strength.Studies have shown a positive correlation between hip fractures and an increased risk of falls in the elderly.Assessment of fall risk is also an important tool for predicting hip fractures.Part?Objective: This study aims to systemically evaluate the complex associations between risk of hip osteoprotic fracture(OF)and hip geometric parameters,and to estimate the parameters' predictive capacity of hip OF.Participants and methods:Based on 6,294 recruited Chinese(?65 yrs),97 subjects with OF history and 388 matched controls were selected.Bone mineral density(BMD)was measured by dual-energy X-ray absorptiometry(DXA).Thirty subparts of total hip(narrow neck;NN;Intertrochanter,IT;femoral shaft,FS)were obtained by Hip Structural Analysis(HSA).Seven traditional geometric parameters of femoral neck were calculated by formula.The t test and chi-square statistics were used to compare the differences of characteristics.Conditional logistic regression model was used to estimate odds ratios(OR)of parameters on hip OF.Results:(1)Three geometric parameters(endocortical diameter,ED;cortical thickness,CT;buckling ratio,BR)have consistent differences at all the sites between the cases and controls(p< 0.01).(2)Conventional geometry parameters(e.g.,cross-sectional area,CSA;BR)and the newly developed parameters(e.g.,NN_ED,NN_OD,IT_ED)were identified as the risk factors of hip fracture independent of bone mineral density(BMD).(3)The predictive ability of hip fracture(receiver operating characteristic curve(ROC)analysis)was improved when combined with the significant independent hip geometric parameters,especially at NN,the area of ROC(AUC)used single NN_BMD is only 0.596,but increased rapidly at 0.705 when combined.Conclusions: This study systemically evaluated complex associations between risk of hip fracture and a large hip geometry profile in China.The results will increase our understanding of the determinants of fracture and provide potential clue for future prevention of fracture for Chinese.Part ?Objective: This study aims to investigate the relationship between fall risk assessment and hip low traumatic fracture,and to evaluate its predictive ability.Participants and methods: There were 97 patients over 65 years old with recent history of low traumatic hip fracture,and 388 controls with no history of fracture who were matched as 1:4 ratio according to age and sex.A modified FROP-Com-based questionnaire survey and a balance ability test were conducted to compare the scores between the cases and the controls.The risk factors of hip fracture were obtained by Logistic regression analysis.The area under ROC(AUC)curve was used to predict hip fracture.Results: There were significant differences in the scores of Static_equilibrium ability,posture control ability and dynamic_equilibrium ability between the cases and controls.The total score of balance ability test and the total score of falling risk assessment including FROP-Com and balance ability test also showed statistical difference between fracture group and non-fracture group,and the score of fracture group was higher than that of non-fracture group.Logistic regression analysis showed that the high score of those tools above were the risk factors of hip fracture,and could predict the incident of fracture.Conclusion:High score of fall risk assessment is a risk factor for low traumatic hip fracture and is an important and effective tool for prediction.Fall risk assessment provides a reliable reference for secondary prevention of hip fractures.