Related Experiment Video
Updated: Apr 16, 2026
Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Hip axis length is a FRAX- and bone density-independent risk factor for hip fracture in women
William D Leslie1, Lisa M Lix, Suzanne N Morin
1Department of Medicine (W.D.L., S.N.M.), and Department of Community Health Sciences (L.M.L.), University of Manitoba, Winnipeg, Canada R2H 2A6; and Centre for Metabolic Bone Diseases (H.J., A.O., E.V.M., J.A.K.), Sheffield S5 7AU, United Kingdom.
Context:
Bone mineral density (BMD) measurement from dual-energy X-ray absorptiometry (DXA) is widely used to assess skeletal strength in clinical practice, but DXA instruments can also measure biomechanical parameters related to skeletal shape.
Objective:
The objective of the study was to determine whether DXA-derived hip geometry measures provide information on fracture prediction that is independent of hip fracture probability determined from the fracture risk assessment tool (FRAX) algorithm.
Design And Setting:
This was a retrospective registry study using BMD results for Manitoba, Canada.
Patients:
Women aged 40 years and older with baseline hip DXA, derived hip geometry measures, and FRAX scores (n = 50 420) participated in the study.
Main Outcome Measures:
Hospitalized hip fracture (n = 1020) diagnosed during 319 137 person-years of follow-up (median 6.4 y) was measured.
Results:
Among the hip geometry measures, hip axis length (HAL) showed a consistent association with hip fracture risk when adjusted for age [hazard ratio (HR) 1.30 per SD increase, 95% confidence interval (CI) 1.22-1.38], and this was unaffected by further adjustment for BMD or FRAX score. Adjusted for FRAX score with BMD, there was a significant effect of increasing HAL quintile on hip fracture risk (linear trend P < .001); relative to quintile 1 (referent), the HR increased from 1.43 (95% CI 1.12-1.82) for quintile 2, 1.61 (95% CI 1.27-2.04) for quintile 3, 1.85 (95% CI 1.47-2.32) for quintile 4, and 2.45 (95% CI 1.96-3.05) for quintile 5. There was a modest but significant improvement in net reclassification improvement (1.5%) and integrated discrimination improvement (0.7%) indices. The effect of HAL was particularly strong among younger, nonosteoporotic women (FRAX adjusted HR 1.70 per SD increase, 95% CI 1.48-1.94).
Conclusions:
DXA-derived hip geometry measurements are associated with incident hip fracture risk, but many do not confer significant independent predictive information. HAL was found to predict hip fractures when adjusted for BMD or FRAX score and may be of clinical value in refining hip fracture risk.
Related Concept Videos
01:16Bones of the Lower Limb: Femur and Patella
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
01:09Changes in the Appendicular Skeleton with Age
Initially, the limb buds consist of a core of mesenchyme covered by a layer of ectoderm. The ectoderm at the end of the limb bud thickens to form a narrow crest called the apical ectodermal ridge. This ridge stimulates the underlying...