TY - JOUR
TI - Improving risk assessment: Hip geometry, bone mineral distribution and
bone strength in hip fracture cases and controls. The EPOS study
AU - Crabtree, NJ
AU - Kroger, H
AU - Martin, A
AU - Pols, HAP
AU - Lorenc, R and
AU - Nijs, J
AU - Stepan, JJ
AU - Falch, JA
AU - Miazgowski, T
AU - Grazio, S and
AU - Raptou, P
AU - Adams, J
AU - Collings, A
AU - Khaw, KT
AU - Rushton, N and
AU - Lunt, M
AU - Dixon, AK
AU - Reeve, J
JO - Osteoporosis International
PY - 2002
VL - 13
TODO - 1
SP - 48-54
PB - Springer-Verlag London Ltd
SN - 0937-941X, 1433-2965
TODO - 10.1007/s198-002-8337-y
TODO - bone biomechanics; bone densitometry; DXA; hip fracture; hip strength
analysis
TODO - Hip geometry and bone mineral density (BMD) have previously been shown
to relate independently to hip fracture risk. Our objective was to
determine by how much hip geometric data improved the identification of
hip fracture. Lunar pencil beam scans of the proximal femur were
obtained. Geometric and densitometric values from 800 female controls
aged 60 years or more (from population samples which were participants
in the European Prospective Osteoporosis Study. EPOS) were compared with
data from 68 female hip fracture patients aged over 60 years who were
scanned within 4 weeks of a contralateral hip fracture. We used Lunar
DPX ‘beta’ versions of hip strength analysis (HSA) and hip axis length
(HAL) applied to DPX(L) data. Compressive stress (Cstress), calculated
by the HSA software to occur as a result of a typical fall on the
greater trochanter. HAL, body mass index (BMI: weight/(height)) and age
were considered alongside femoral neck BMD (FN-BMD, g/cm(2)) as
potential predictors of fracture. Logistic regression was used to
generate predictors of fracture initially from FN-BMD. Next age, Cstress
(as the most discriminating HSA-derived parameter), HAL and BMI were
added to the model as potentially independent predictors. It was not
necessary to include both HAL and Cstress in the logistic models. so the
entire data set was examined without excluding the subjects missing HAL
measurements. Cstress combined with age and BMI provided significantly
better prediction of fracture than FN-BMD used alone as is current
practice, judged by comparing areas under receiver operating
characteristic (ROC) curves (p<0.001, deLong’s test). At a specificity
of 80%, sensitivity in identification was improved from 66% to 81%.
Identifying women at high risk of hip fracture is thus likely to be
substantially enhanced by combining bone density with age, simple
anthropometry and data on the structural geometry of the hip. HSA might
prove to be a valuable enhancement of DXA densitometry in clinical
practice and its use could justify a more proactive approach to
identifying women at high risk of hip fracture in the community.
ER -