Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2022; 13(2): 160-170
Published online Feb 18, 2022. doi: 10.5312/wjo.v13.i2.160
Bone mineral density in fracture neck of femur patients: What's the significance?
Hussam Elamin Ahmed, Oday Al-Dadah
Hussam Elamin Ahmed, Oday Al-Dadah, Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside NE34 0PL, United Kingdom
Oday Al-Dadah, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE2 4HH, United Kingdom
Author contributions: Elamin Ahmed H contributed to study design, literature review and manuscript production; Al-Dadah O contributed to study design, literature review, statistical analysis and manuscript production.
Institutional review board statement: This was a retrospective observational cohort study which did not require IRB/ Ethics Committee approval.
Informed consent statement: Informed consent was obtained from all patients as part of their routine clinical care in this pragmatic study which evaluated the existing clinical practice within the department.
Conflict-of-interest statement: The authors report no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Noncommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hussam Elamin Ahmed, MBBS, Doctor, Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside NE34 0PL, United Kingdom. hussam.elamin-ahmed@nhs.net
Received: May 9, 2021
Peer-review started: May 9, 2021
First decision: June 16, 2021
Revised: July 1, 2021
Accepted: January 11, 2022
Article in press: January 11, 2022
Published online: February 18, 2022
Processing time: 284 Days and 16.6 Hours
Abstract
BACKGROUND

The National Institute for Health and Care Excellence (NICE) guidelines have advised further research is required into investigating the added prognostic value of bone mineral density (BMD) in the assessment of fracture risk with the Fracture Risk Assessment Tool (FRAX) score.

AIM

To investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.

METHODS

Inclusion criteria for this study were all patients who underwent dual-energy X-ray absorptiometry (DXA) scan following fracture neck of femur between 2015 and 2017. Analysis of BMD, FRAX scores and patient demographic data was undertaken.

RESULTS

A total of 69 patients were included in the study, mean age 74.1 years. There was no significant difference between mean BMD of the femoral neck in males (0.65) as compared to females (0.61) (P = 0.364). Analyses showed no significant correlation between BMD and menopause age (rs = -0.28, P = 0.090). A significant difference was seen of the femoral neck BMD between the different fracture pattern types (P = 0.026). A stronger correlation was observed between BMD of femoral neck and FRAX major score (rs = -0.64, P < 0.001) than with BMD of lumbar spine and FRAX major score (rs = -0.37, P = 0.003).

CONCLUSION

This study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.

Keywords: Fracture neck of femur; Bone mineral density; Fracture Risk Assessment Tool score; Fragility fracture; Osteoporosis

Core Tip: The results in this study place more emphasis on bone mineral density (BMD) when assessing fracture risk, in comparison to key factors incorporated into the Fracture Risk Assessment Tool (FRAX) predictive score. Menopause age and female gender had an indeterminate influence on BMD, as well as World Health Organization classification of osteoporosis. Body mass index had a significant influence on BMD. Osteoporosis was more common in patients with extra-capsular hip fracture patterns. This study shows that BMD is significant in assessing risk of fracture neck of femur in comparison to the FRAX predictive score.