The authors state that they have no conflicts of interest.
Article first published online: 17 MAR 2008
Copyright © 2008 ASBMR
Journal of Bone and Mineral Research
Volume 23, Issue 8, pages 1326–1333, August 2008
How to Cite
Black, D. M., Bouxsein, M. L., Marshall, L. M., Cummings, S. R., Lang, T. F., Cauley, J. A., Ensrud, K. E., Nielson, C. M. and Orwoll, E. S. (2008), Proximal Femoral Structure and the Prediction of Hip Fracture in Men: A Large Prospective Study Using QCT. J Bone Miner Res, 23: 1326–1333. doi: 10.1359/jbmr.080316
Published online on March 17, 2008;
- Issue published online: 4 DEC 2009
- Article first published online: 17 MAR 2008
- Manuscript Accepted: 12 MAR 2008
- Manuscript Revised: 7 MAR 2008
- Manuscript Received: 7 DEC 2007
- hip fracture;
- hip structure;
The structure of the femoral neck contributes to hip strength, but the relationship of specific structural features of the hip to hip fracture risk is unclear. The objective of this study is to determine the contribution of structural features and volumetric density of both trabecular and cortical bone in the proximal femur to the prediction of hip fracture in older men. Baseline QCT scans of the hip were obtained in 3347 men ≥65 yr of age enrolled in the Osteoporotic Fractures in Men Study (MrOS). All men were followed prospectively for an average of 5.5 yr. Areal BMD (aBMD) by DXA was also assessed. We determined the associations between QCT-derived measures of femoral neck structure, volumetric bone density, and hip fracture risk. Forty-two men sustained incident hip fractures during follow-up: an overall rate of 2.3/1000 person-years. Multivariable analyses showed that, among the QCT-derived measures, lower percent cortical volume (hazard ratio [HR] per SD decrease: 3.2; 95% CI: 2.2–4.6), smaller minimal cross-sectional area (HR: 1.6; 95% CI: 1.2–2.1), and lower trabecular BMD (HR: 1.7; 95% CI: 1.2–2.4) were independently related to increased hip fracture risk. Femoral neck areal BMD was also strongly related to hip fracture risk (HR: 4.1; 95% CI: 2.7–6.4). In multivariable models, percent cortical volume and minimum cross-sectional area remained significant predictors of hip fracture risk after adjustment for areal BMD, but overall prediction was not improved by adding QCT parameters to DXA. Specific structural features of the proximal femur were related to an increased risk of hip fracture. Whereas overall hip fracture prediction was not improved relative to aBMD, by adding QCT parameters, these results yield useful information concerning the causation of hip fracture, the evaluation of hip fracture risk, and potential targets for therapeutic intervention.