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Hip structural geometry and incidence of hip fracture in postmenopausal women: What does it add to conventional bone mineral density?

LaCroix, AZ and Beck, TJ and Cauley, JA and Lewis, CE and Bassford, T and Jackson, R and Wu, G and Chen, Z (2010) Hip structural geometry and incidence of hip fracture in postmenopausal women: What does it add to conventional bone mineral density? Osteoporosis International, 21 (6). 919 - 929. ISSN 0937-941X

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Hip geometry measurements of outer diameter and buckling ratio at the intertrochanter and shaft of the hip dual energy X-ray absorptiometry (DXA) scan predicted incident hip fracture in postmenopausal women. These associations, independent of age, body size, clinical risk factors, and conventional areal bone mineral density, suggest hip geometry plays a role in fracture etiology and may aid in improving identification of older women at high fracture risk. Introduction This study examined whether hip geometry parameters predicted hip fracture independent of body size, clinical risk factors, and conventional femoral neck bone mineral density (aBMD) and whether summary factors could be identified to predict hip fracture. Methods We studied 10,290 postmenopausal women from the Women's Health Initiative. Eight thousand eight hundred forty-three remained fracture free during followup to 11 years of follow-up, while 147 fractured their hip, and 1,300 had other clinical fractures. Hip structural analysis software measured bone cross-sectional area, outer diameter, section modulus, average cortical thickness, and buckling ratio on archived DXA scans in three hip regions: narrow neck, intertrochanter, and shaft. Hazard ratios were estimated using Cox proportional hazards models for individual parameters and for composite factors extracted from principal components analysis from all 15 parameters. Results After adjustment for age, body size, clinical risk factors, and aBMD, intertrochanter and shaft outer diameter measurements remained independent predictors of hip fracture with hazard ratios for a one standard deviation increase of 1.61 (95% confidence interval (CI), 1.25-2.08) for the intertrochanter and 1.36 (95% CI, 1.06-1.76) for the shaft. Average buckling ratios also independently predicted incident hip fracture with hazard ratios of 1.43 (95% CI, 1.10-1.87) at the intertrochanter and 1.24 (95% CI, 1.00-1.55) at the shaft. Although two composite factors were extracted from principal components analysis, neither was superior to these individual measurements at predicting incident hip fracture. Conclusions Two hip geometry parameters, intertrochanter outer diameter and buckling ratio, predict incident hip fracture after accounting for clinical risk factors and aBMD. © International Osteoporosis Foundation and National Osteoporosis Foundation 2009.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
LaCroix, AZ
Beck, TJ
Cauley, JAJCauley@edc.pitt.eduJCAULEY
Lewis, CE
Bassford, T
Jackson, R
Wu, G
Chen, Z
Date: 1 June 2010
Date Type: Publication
Journal or Publication Title: Osteoporosis International
Volume: 21
Number: 6
Page Range: 919 - 929
DOI or Unique Handle: 10.1007/s00198-009-1056-1
Schools and Programs: Graduate School of Public Health > Epidemiology
Refereed: Yes
ISSN: 0937-941X
Date Deposited: 23 Nov 2015 20:18
Last Modified: 02 Feb 2019 15:55


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