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Coxarthrosis and femoral neck fracture
1Bone Disease Research Group, Clinical Research Centre, Harrow, United Kingdom.
Insights
Osteoarthritis (coxarthrosis) may protect against hip fractures by preserving femoral neck bone density. This study suggests a link between osteoarthritis and better bone integrity in older women.
Area of Science:
- Orthopedics
- Gerontology
- Radiology
Background:
- Hip fractures are a major health concern in aging populations.
- Trabecular bone integrity, assessed by the Singh index, is crucial for bone strength.
- Osteoarthritis (coxarthrosis) is a common condition in older adults, potentially affecting bone health.
Purpose of the Study:
- To investigate the relationship between hip fracture, femoral neck trabecular bone integrity (Singh index), osteoarthrosis, and age.
- To determine if osteoarthrosis influences fracture risk or bone density in hip fracture patients.
Main Methods:
- Retrospective cross-sectional study of 300 hip fracture patients and 300 matched controls.
- Analysis of hip roentgenograms to assess fracture type and Singh index.
- Comparison of Singh index between fracture patients and controls, with and without exclusion of coxarthrosis patients.
Main Results:
- Coxarthrosis was linked to lower rates of intracapsular hip fractures but not extracapsular fractures.
- Singh grade decreased with age across all groups.
- Female patients with coxarthrosis showed a reduced rate of Singh grade decline compared to other groups.
- When coxarthrosis patients were included, female fracture patients had significantly lower mean Singh grades than controls.
Conclusions:
- The presence of coxarthrosis may be associated with preserved trabecular bone integrity in the femoral neck.
- Previous observations of lower bone density in hip fracture patients might be influenced by an undetected association between coxarthrosis and bone integrity.
- Further research is needed to clarify the protective role of coxarthrosis against hip fractures.
Abstract:
A retrospective cross-sectional study of the roentgenograms of 300 hip fracture patients and 300 age- and gender-matched controls was performed to determine the relationship between fracture type, femoral neck trabecular bone integrity (as measured by the Singh index), osteoarthrosis, and age. Coxarthrosis was associated with a low incidence of intracapsular fracture but unchanged rates of extracapsular fracture. Singh grade declined with age in all groups of patients, although the rate of decline was reduced in control female patients with coxarthrosis compared with other diagnostic groups. When the coxarthrosis patients were included, the mean Singh grade for the female fracture patients was significantly reduced in patients compared with controls with or without age adjustment (3.88 versus 4.17). When patients with coxarthrosis were excluded from the analysis, this effect disappeared. It is suggested that the differences in Singh grades observed previously between femoral fracture patients and controls may have resulted from an undetected negative association between coxarthrosis and retention of trabecular integrity with aging.