Document Type: RESEARCH PAPER
University of Rochester School of Medicine & Dentistry, Rochester, USA
Department of Orthopaedic Surgery, JPS Health Network, Fort Worth, USA
Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, USA
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
Department of Orthopaedic Surgery, Acclaim Physician Group, Ben Hogan Center, Fort Worth, USA
Background: A better understanding of how bone mineral density and vitamin D levels are associated with femoral
neck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years,
is there a difference in quantitative ultrasound of the heel (QUS) t-score between patients with fractures of the femoral
neck and those with fractures of the intertrochanteric region, accounting for other factors 2) In patients age ≥ 55 years,
is there a difference in vitamin D level between those with fractures of the femoral neck and those with fractures of the
intertrochanteric region, accounting for other factors? 3) Is there an association between vitamin D level and QUS t-score?
Methods: In this retrospective cohort study, 1,030 patients were identified using CPT codes for fixation of hip fractures
between December 2010 and September 2013. Patients ≥ 55 years of age who underwent operative management for
a hip fracture following a fall from standing height were included. Three orthopaedic surgeons categorized fracture type
using patient radiographs. Upon hospital admission, QUS t-scores and vitamin D levels were determined. Descriptive
statistics, bivariate analyses and multivariable regression were performed.
Results: Accounting for potential confounders, patients with lower QUS t-scores were more likely to have intertrochanteric
femur fractures than femoral neck fractures. In a bivariate analysis, there was no association between vitamin D level
and either fracture type. There was no association between vitamin D level and bone mineral density.
Conclusion: Patients with lower bone density that fracture their hips are more likely to fracture in the intertrochanteric
region than the femoral neck, but vitamin D levels are unrelated. Awareness of this association emphasizes the
importance of bone mineral density screening to assist with intertrochanteric hip fracture prevention.
Level of evidence: III