Association between quantitative CT-derived hip bone mineral density and all-cause mortality in elderly women after hip fracture surgery
10.3760/cma.j.cn115530-20250430-00188
- VernacularTitle:定量CT测量的髋部骨密度与老年女性髋部骨折患者术后全因死亡的相关性研究
- Author:
Jiusheng HE
1
;
Chuying CHEN
;
Lin LI
;
Minghui YANG
;
Xinbao WU
Author Information
1. 北京市顺义区医院创伤骨科，北京 101300
- Publication Type:Journal Article
- Keywords:
Hip fractures;
Bone density;
Mortality;
Aged;
Quantitative CT
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(9):774-780
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the association between quantitative CT-derived hip bone mineral density (BMD) and all-cause mortality in elderly women after hip fracture surgery.Methods:A retrospective study was conducted to analyze the clinical data of the 254 elderly women with hip fracture who had been surgically treated at Department of Orthopaedics and Traumatology, Shunyi District Hospital between December 2018 and December 2019. Their average age was (79.3±7.7) years. There were 128 femoral neck fractures and 126 intertrochanteric fractures. CT images of their proximal femurs on the healthy side were analyzed using quantitative CT Pro software to assess the BMDs at the femoral neck, greater trochanter, intertrochanteric region, and total hip. The primary endpoint was all-cause mortality during follow-up. The patients were classified into a death group and a censored group (survivors and those lost to follow-up). The secondary outcome was recovery of pre-fracture ambulation. Multivariable Cox proportional hazards regression was performed to evaluate the association between regional hip BMD and mortality risk.Results:Of the patients, 236 obtained a follow-up of 36.9 (32.7, 42.6) months and 18 were lost to the follow-up. A total of 28.3% (72/254) of the patients died within 3 years after surgery. The overall hip BMD [(0.510 9±0.094 3) g/cm 2], the greater trochanter BMD [(0.351 0±0.079 6) g/cm 2], and the intertrochanteric BMD[(0.629 5±0.116 9) g/cm 2] in the death group were significantly lower than those in the censored group [(0.565 8±0.104 1) g/cm 2, (0.398 6±0.092 1) g/cm 2, and (0.685 6±0.126 6) g/cm 2]( P<0.05). The multivariate Cox regression analysis showed that a lower BMD at all hip sites measured was significantly associated with a higher mortality risk before adjustments ( P<0.05), but after confounding variables were adjusted, only the greater trochanter BMD ( HR=1.789, 95% CI: 1.035 to 3.092, P=0.037) and the intertrochanteric BMD ( HR=1.758, 95% CI: 1.018 to 3.037, P=0.043) were significantly associated with a higher mortality risk. Furthermore, follow-ups showed that 54 patients (56.3%, 54/96) in the high trochanter BMD group regained their pre-fracture ambulatory status, significantly more than the 22 patients in the low BMD group (32.4%, 22/68), showing an increased odds of ambulation recovery ( OR=2.688, 95% CI: 1.405 to 5.143, P=0.003). Conclusion:In elderly women with hip fracture, quantitative CT-derived measurement of the hip BMD, particularly in the trochanteric region, can serve as an early warning indicator of all-cause mortality after hip fracture surgery.
