Association Between Hip Bone Mineral Density and Mortality Risk After Hip Fracture: A Prospective Cohort Study

Area of Science:

• Gerontology
• Orthopedics
• Radiology

Background:

• Osteoporotic hip fractures (HF) are a significant cause of mortality in the elderly.
• Proximal femoral bone mineral density (BMD), a primary factor in osteoporosis, has been understudied regarding its association with post-HF mortality.

Purpose of the Study:

• To investigate the association between hip bone mineral density (BMD) and mortality risk in elderly patients following a hip fracture.
• To determine if specific hip BMD measurements are independent predictors of postoperative mortality.

Main Methods:

• A prospective study followed 411 elderly patients with hip fractures in Beijing, China, for a median of 3 years.
• Quantitative CT (QCT) measured areal BMD (aBMD) of the unaffected hip, analyzing total hip (TH), femoral neck (FN), and trochanter (TR) regions.
• Postoperative mortality was the primary outcome, with statistical analysis including adjusted models and survival analysis.

Main Results:

• Of 394 patients analyzed, 86 died during follow-up.
• Initially, all hip BMD measures correlated with mortality, but only trochanter (TR) aBMD remained significant after adjusting for covariates.
• Higher TR aBMD was associated with significantly lower death risks (HR 0.21; P=0.036).
• Survival analysis showed higher survival probabilities for patients with higher TH and TR aBMD (P < 0.001).

Conclusions:

• Hip bone mineral density, especially trochanter BMD assessed by QCT, is an independent risk factor for postoperative mortality after hip fracture.
• QCT offers a potential method for opportunistic analysis in immobilized patients, aiding early detection and personalized interventions to improve outcomes.