HIP FRACTURES IN THE AGED 80 YEARS AND OVER WITH OSTEOPOROSIS ARE NOT ALL THE SAME

Abstract

Knowing patient bone density is important to select the proper fixation technique and for secondary osteoporosis medical treatment. However few studies addressing hip fractures provided data regarding patient bone mineral density.

Materials and Methods: Four hundred and thirty three consecutive female patients were included in our study. Inclusion criteria were: AO/OTA fracture type A1, A2 or B, age ? 80 years and minor trauma. BMD values of the lumbar spine (L2–L4) and right proximal femur (neck, trochanter, Ward’s triangle) were measured by dual-energy x-ray absorptiometry. Patients were divided into three groups: Group A had trochanteric fractures (n = 79, average age 85 ? 5), Group B had femoral neck fractures (n = 67, age 84 ? 4) and Group C had no fractures (n = 287, age 82 ? 2). Data was assessed statistically using Analysis of Variance (ANOVA) and receiver operating characteristic (ROC) analysis.

Results: Group A ROC curve had higher values when compared to Group B ROC curve in all corresponding BMD tested sites. Total number of patients with femoral neck fracture and a T-score higher then −2.5 SD were 14 (20.9%), 25 (37.3%) and 16 (23.9%) at the femoral neck, trochanter and at the Ward’s triangle respectively. Patients with a trochanteric fracture and a T-score higher than −2.5 SD were 8 (10.1%), 15 (19.0%) and 12 (15.2%) at the femoral neck, trochanter and Ward’s triangle respectively. BMD values at the trochanteric measurement site demonstrated that the incident rate between the two patient groups differed significantly depending on the diagnosis of osteoporosis (Chi square test: X² = 6.12, p = 0.013).

Discussion: There are notable differences in bone mass density. Femoral neck BMD proved to be the best diagnostic site using DXA, with 15.07% of hip fracture patients having a normal age-related bone mass. Higher non-osteoporotic bone densities were found in women with hip fractures: BMD values were (27.40%) at the trochanter and (17.81%) at the Ward’s triangle.

Conclusions: There was a significant difference between non-osteoporotic related fractures in Group A and Group B. There were more non-osteoporotic related fractures in Group B. A lower BMD was found in patients with trochanteric fractures than in patients with femoral neck fractures. Assessment of bone quality in these patients is of paramount importance in choosing the correct surgical treatment. In patients with poor bone quality, fixation augmentation techniques can be used. We recommend routine DXA scans of the affected fractured hip in all elderly hip fracture patients prior to surgery.