Lower Bone Mineral Density is Associated with Intertrochanteric Hip Fracture

Document Type: RESEARCH PAPER

Authors

1 University of Rochester School of Medicine & Dentistry, Rochester, USA

2 Department of Orthopaedic Surgery, JPS Health Network, Fort Worth, USA

3 Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, USA

4 Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA

5 Department of Orthopaedic Surgery, Acclaim Physician Group, Ben Hogan Center, Fort Worth, USA

Abstract

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

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