Skip to main content
Erschienen in: Osteoporosis International 5/2010

01.05.2010 | Original Article

Women with hip fracture experience greater loss of geometric strength in the contralateral hip during the year following fracture than age-matched controls

verfasst von: L. Reider, T. J. Beck, M. C. Hochberg, W. G. Hawkes, D. Orwig, J. A. YuYahiro, J. R. Hebel, J. Magaziner, for the Study of Osteoporotic Fractures Research Group

Erschienen in: Osteoporosis International | Ausgabe 5/2010

Einloggen, um Zugang zu erhalten

Abstract

Summary

This study examined femur geometry underlying previously observed decline in BMD of the contralateral hip in older women the year following hip fracture compared to non-fractured controls. Compared to controls, these women experienced a greater decline in indices of bone structural strength, potentially increasing the risk of a second fracture.

Introduction

This study examined the femur geometry underlying previously observed decline in BMD of the contralateral hip in the year following hip fracture compared to non-fractured controls.

Methods

Geometry was derived from dual-energy X-ray absorptiometry scan images using hip structural analysis from women in the third cohort of the Baltimore Hip Studies and from women in the Study of Osteoporotic Fractures. Change in BMD, section modulus (SM), cross-sectional area (CSA), outer diameter, and buckling ratio (BR) at the narrow neck (NN), intertrochanteric (IT), and shaft (S) regions of the hip were compared.

Results

Wider bones and reduced CSA underlie the significantly lower BMD observed in women who fractured their hip resulting in more fragile bones expressed by a lower SM and higher BR. Compared to controls, these women experienced a significantly greater decline in CSA (−2.3% vs. −0.2%NN, −3.2% vs. −0.5%IT), SM (−2.1% vs. −0.2%NN, −3.9% vs. −0.6%IT), and BMD (−3.0% vs. −0.8%NN, −3.3% vs. −0.6%IT, −2.3% vs. −0.2%S) and a greater increase in BR (5.0% vs. 2.1%NN, 6.0% vs. 1.3%IT, 4.4% vs. 1.0%S) and shaft outer diameter (0.9% vs. 0.1%).

Conclusion

The contralateral femur continued to weaken during the year following fracture, potentially increasing the risk of a second fracture.
Literatur
1.
Zurück zum Zitat Vestergaard P, Rejnmark L, Mosekilde L (2007) Has mortality after a hip fracture increased? J Am Geriatr Soc 55:1720–1726CrossRefPubMed Vestergaard P, Rejnmark L, Mosekilde L (2007) Has mortality after a hip fracture increased? J Am Geriatr Soc 55:1720–1726CrossRefPubMed
2.
Zurück zum Zitat Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS, Hebel JR (1997) Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health 87:1630–1636CrossRefPubMed Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS, Hebel JR (1997) Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health 87:1630–1636CrossRefPubMed
3.
Zurück zum Zitat Penrod JD, Litke A, Hawkes WG, Magaziner J, Koval KJ, Doucette JT, Silberzweig SB, Siu AL (2007) Heterogeneity in hip fracture patients: age, functional status, and comorbidity. J Am Geriatr Soc 55:407–413CrossRefPubMed Penrod JD, Litke A, Hawkes WG, Magaziner J, Koval KJ, Doucette JT, Silberzweig SB, Siu AL (2007) Heterogeneity in hip fracture patients: age, functional status, and comorbidity. J Am Geriatr Soc 55:407–413CrossRefPubMed
4.
Zurück zum Zitat Fredman L, Magaziner J, Hawkes W, Hebel JR, Fried LP, Kasper J, Guralnik J (2005) Female hip fracture patients had poorer performance-based functioning than community-dwelling peers over 2-year follow-up period. J Clin Epidemiol 58:1289–1298CrossRefPubMed Fredman L, Magaziner J, Hawkes W, Hebel JR, Fried LP, Kasper J, Guralnik J (2005) Female hip fracture patients had poorer performance-based functioning than community-dwelling peers over 2-year follow-up period. J Clin Epidemiol 58:1289–1298CrossRefPubMed
5.
Zurück zum Zitat Magaziner J, Fredman L, Hawkes W, Hebel JR, Zimmerman S, Orwig DL, Wehren L (2003) Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. Am J Epidemiol 157:1023–1031CrossRefPubMed Magaziner J, Fredman L, Hawkes W, Hebel JR, Zimmerman S, Orwig DL, Wehren L (2003) Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. Am J Epidemiol 157:1023–1031CrossRefPubMed
6.
Zurück zum Zitat Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498–M507PubMed Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498–M507PubMed
7.
Zurück zum Zitat Chapurlat RD, Bauer DC, Nevitt M, Stone K, Cummings SR (2003) Incidence and risk factors for a second hip fracture in elderly women. The study of osteoporotic fractures. Osteoporos Int 14:130–136PubMed Chapurlat RD, Bauer DC, Nevitt M, Stone K, Cummings SR (2003) Incidence and risk factors for a second hip fracture in elderly women. The study of osteoporotic fractures. Osteoporos Int 14:130–136PubMed
8.
Zurück zum Zitat Melton LJ 3rd, Kearns AE, Atkinson EJ, Bolander ME, Achenbach SJ, Huddleston JM, Therneau TM, Leibson CL (2008) Secular trends in hip fracture incidence and recurrence. Osteoporos Int . doi:10.1007/s00198-008-0742-8 Melton LJ 3rd, Kearns AE, Atkinson EJ, Bolander ME, Achenbach SJ, Huddleston JM, Therneau TM, Leibson CL (2008) Secular trends in hip fracture incidence and recurrence. Osteoporos Int . doi:10.​1007/​s00198-008-0742-8
10.
Zurück zum Zitat Berry SD, Samelson EJ, Hannan MT, McLean RR, Lu M, Cupples LA, Shaffer ML, Beiser AL, Kelly-Hayes M, Kiel DP (2007) Second hip fracture in older men and women: the Framingham Study. Arch Intern Med 167:1971–1976CrossRefPubMed Berry SD, Samelson EJ, Hannan MT, McLean RR, Lu M, Cupples LA, Shaffer ML, Beiser AL, Kelly-Hayes M, Kiel DP (2007) Second hip fracture in older men and women: the Framingham Study. Arch Intern Med 167:1971–1976CrossRefPubMed
12.
Zurück zum Zitat Magaziner J, Wehren L, Hawkes WG, Orwig D, Hebel JR, Fredman L, Stone K, Zimmerman S, Hochberg MC (2006) Women with hip fracture have a greater rate of decline in bone mineral density than expected: another significant consequence of a common geriatric problem. Osteoporos Int 17:971–977CrossRefPubMed Magaziner J, Wehren L, Hawkes WG, Orwig D, Hebel JR, Fredman L, Stone K, Zimmerman S, Hochberg MC (2006) Women with hip fracture have a greater rate of decline in bone mineral density than expected: another significant consequence of a common geriatric problem. Osteoporos Int 17:971–977CrossRefPubMed
13.
Zurück zum Zitat Hayes W, Bouxsein M (1997) Biomechanics of cortical and trabecular bone: implications for assessment of fracture risk. In: Mow V, Hayes W (eds) Basic orthopaedic biomechanics. Lippincott-Raven, Philadelphia, pp 66–111 Hayes W, Bouxsein M (1997) Biomechanics of cortical and trabecular bone: implications for assessment of fracture risk. In: Mow V, Hayes W (eds) Basic orthopaedic biomechanics. Lippincott-Raven, Philadelphia, pp 66–111
14.
Zurück zum Zitat Fox KM, Magaziner J, Hawkes WG, Yu-Yahiro J, Hebel JR, Zimmerman SI, Holder L, Michael R (2000) Loss of bone density and lean body mass after hip fracture. Osteoporos Int 11:31–35CrossRefPubMed Fox KM, Magaziner J, Hawkes WG, Yu-Yahiro J, Hebel JR, Zimmerman SI, Holder L, Michael R (2000) Loss of bone density and lean body mass after hip fracture. Osteoporos Int 11:31–35CrossRefPubMed
15.
Zurück zum Zitat Cummings SR, Black DM, Nevitt MC, Browner WS, Cauley JA, Genant HK, Mascioli SR, Scott JC, Seeley DG, Steiger P (1990) Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group. JAMA 263:665–668CrossRefPubMed Cummings SR, Black DM, Nevitt MC, Browner WS, Cauley JA, Genant HK, Mascioli SR, Scott JC, Seeley DG, Steiger P (1990) Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group. JAMA 263:665–668CrossRefPubMed
16.
Zurück zum Zitat Martin RB, Burr DB (1984) Non-invasive measurement of long bone cross-sectional moment of inertia by photon absorptiometry. J Biomech 17:195–201CrossRefPubMed Martin RB, Burr DB (1984) Non-invasive measurement of long bone cross-sectional moment of inertia by photon absorptiometry. J Biomech 17:195–201CrossRefPubMed
17.
Zurück zum Zitat Beck TJ (2007) Extending DXA beyond bone mineral density: understanding hip structure analysis. Curr Osteoporos Rep 2:49–55CrossRef Beck TJ (2007) Extending DXA beyond bone mineral density: understanding hip structure analysis. Curr Osteoporos Rep 2:49–55CrossRef
18.
Zurück zum Zitat Kaptoge S, Beck TJ, Reeve J, Stone KL, Hillier TA, Cauley JA, Cummings SR (2008) Prediction of incident hip fracture risk by femur geometry variables measured by hip structural analysis in the study of osteoporotic fractures. J Bone Miner Res . doi:10.1359/jbmr.080802 PubMed Kaptoge S, Beck TJ, Reeve J, Stone KL, Hillier TA, Cauley JA, Cummings SR (2008) Prediction of incident hip fracture risk by femur geometry variables measured by hip structural analysis in the study of osteoporotic fractures. J Bone Miner Res . doi:10.​1359/​jbmr.​080802 PubMed
19.
Zurück zum Zitat Rivadeneira F, Zillikens MC, De Laet CE, Hofman A, Uitterlinden AG, Beck TJ, Pols HA (2007) Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam Study. J Bone Miner Res 22:1781–1790CrossRefPubMed Rivadeneira F, Zillikens MC, De Laet CE, Hofman A, Uitterlinden AG, Beck TJ, Pols HA (2007) Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam Study. J Bone Miner Res 22:1781–1790CrossRefPubMed
20.
Zurück zum Zitat Khoo BC, Beck TJ, Qiao QH, Parakh P, Semanick L, Prince RL, Singer KP, Price RI (2005) In vivo short-term precision of hip structure analysis variables in comparison with bone mineral density using paired dual-energy X-ray absorptiometry scans from multi-center clinical trials. Bone 37:112–121CrossRefPubMed Khoo BC, Beck TJ, Qiao QH, Parakh P, Semanick L, Prince RL, Singer KP, Price RI (2005) In vivo short-term precision of hip structure analysis variables in comparison with bone mineral density using paired dual-energy X-ray absorptiometry scans from multi-center clinical trials. Bone 37:112–121CrossRefPubMed
21.
Zurück zum Zitat Mikkola T, Sipila S, Portegijs E, Kallinen M, Alen M, Kiviranta I, Pekkonen M, Heinonen A (2007) Impaired geometric properties of tibia in older women with hip fracture history. Osteoporos Int 18:1083–1090CrossRefPubMed Mikkola T, Sipila S, Portegijs E, Kallinen M, Alen M, Kiviranta I, Pekkonen M, Heinonen A (2007) Impaired geometric properties of tibia in older women with hip fracture history. Osteoporos Int 18:1083–1090CrossRefPubMed
22.
Zurück zum Zitat Akesson K, Kakonen SM, Josefsson PO, Karlsson MK, Obrant KJ, Pettersson K (2005) Fracture-induced changes in bone turnover: a potential confounder in the use of biochemical markers in osteoporosis. J Bone Miner Metab 23:30–35CrossRefPubMed Akesson K, Kakonen SM, Josefsson PO, Karlsson MK, Obrant KJ, Pettersson K (2005) Fracture-induced changes in bone turnover: a potential confounder in the use of biochemical markers in osteoporosis. J Bone Miner Metab 23:30–35CrossRefPubMed
23.
Zurück zum Zitat Obrant KJ, Ivaska KK, Gerdhem P, Alatalo SL, Pettersson K, Vaananen HK (2005) Biochemical markers of bone turnover are influenced by recently sustained fracture. Bone 36:786–792CrossRefPubMed Obrant KJ, Ivaska KK, Gerdhem P, Alatalo SL, Pettersson K, Vaananen HK (2005) Biochemical markers of bone turnover are influenced by recently sustained fracture. Bone 36:786–792CrossRefPubMed
24.
Zurück zum Zitat Ivaska KK, Gerdhem P, Akesson K, Garnero P, Obrant KJ (2007) Effect of fracture on bone turnover markers: a longitudinal study comparing marker levels before and after injury in 113 elderly women. J Bone Miner Res 22:1155–1164CrossRefPubMed Ivaska KK, Gerdhem P, Akesson K, Garnero P, Obrant KJ (2007) Effect of fracture on bone turnover markers: a longitudinal study comparing marker levels before and after injury in 113 elderly women. J Bone Miner Res 22:1155–1164CrossRefPubMed
25.
Zurück zum Zitat Yu-Yahiro JA, Michael RH, Dubin NH, Fox KM, Sachs M, Hawkes WG, Hebel JR, Zimmerman SI, Shapiro J, Magaziner J (2001) Serum and urine markers of bone metabolism during the year after hip fracture. J Am Geriatr Soc 49:877–883CrossRefPubMed Yu-Yahiro JA, Michael RH, Dubin NH, Fox KM, Sachs M, Hawkes WG, Hebel JR, Zimmerman SI, Shapiro J, Magaziner J (2001) Serum and urine markers of bone metabolism during the year after hip fracture. J Am Geriatr Soc 49:877–883CrossRefPubMed
26.
Zurück zum Zitat Dirschl DR, Henderson RC, Oakley WC (1997) Accelerated bone mineral loss following a hip fracture: a prospective longitudinal study. Bone 21:79–82CrossRefPubMed Dirschl DR, Henderson RC, Oakley WC (1997) Accelerated bone mineral loss following a hip fracture: a prospective longitudinal study. Bone 21:79–82CrossRefPubMed
27.
Zurück zum Zitat Kaptoge S, Dalzell N, Jakes RW, Wareham N, Day NE, Khaw KT, Beck TJ, Loveridge N, Reeve J (2003) Hip section modulus, a measure of bending resistance, is more strongly related to reported physical activity than BMD. Osteoporos Int 14:941–949CrossRefPubMed Kaptoge S, Dalzell N, Jakes RW, Wareham N, Day NE, Khaw KT, Beck TJ, Loveridge N, Reeve J (2003) Hip section modulus, a measure of bending resistance, is more strongly related to reported physical activity than BMD. Osteoporos Int 14:941–949CrossRefPubMed
28.
Zurück zum Zitat Kaptoge S, Jakes RW, Dalzell N, Wareham N, Khaw KT, Loveridge N, Beck TJ, Reeve J (2007) Effects of physical activity on evolution of proximal femur structure in a younger elderly population. Bone 40:506–515CrossRefPubMed Kaptoge S, Jakes RW, Dalzell N, Wareham N, Khaw KT, Loveridge N, Beck TJ, Reeve J (2007) Effects of physical activity on evolution of proximal femur structure in a younger elderly population. Bone 40:506–515CrossRefPubMed
29.
Zurück zum Zitat Uusi-Rasi K, Semanick LM, Zanchetta JR, Bogado CE, Eriksen EF, Sato M, Beck TJ (2005) Effects of teriparatide [rhPTH (1–34)] treatment on structural geometry of the proximal femur in elderly osteoporotic women. Bone 36:948–958CrossRefPubMed Uusi-Rasi K, Semanick LM, Zanchetta JR, Bogado CE, Eriksen EF, Sato M, Beck TJ (2005) Effects of teriparatide [rhPTH (1–34)] treatment on structural geometry of the proximal femur in elderly osteoporotic women. Bone 36:948–958CrossRefPubMed
30.
Zurück zum Zitat Uusi-Rasi K, Beck TJ, Semanick LM, Daphtary MM, Crans GG, Desaiah D, Harper KD (2006) Structural effects of raloxifene on the proximal femur: results from the multiple outcomes of raloxifene evaluation trial. Osteoporos Int 17:575–586CrossRefPubMed Uusi-Rasi K, Beck TJ, Semanick LM, Daphtary MM, Crans GG, Desaiah D, Harper KD (2006) Structural effects of raloxifene on the proximal femur: results from the multiple outcomes of raloxifene evaluation trial. Osteoporos Int 17:575–586CrossRefPubMed
31.
Zurück zum Zitat Wehren LE, Hawkes WG, Hebel JR, Orwig DL, Magaziner J (2005) Bone mineral density, soft tissue body composition, strength, and functioning after hip fracture. J Gerontol A Biol Sci Med Sci 60:80–84PubMed Wehren LE, Hawkes WG, Hebel JR, Orwig DL, Magaziner J (2005) Bone mineral density, soft tissue body composition, strength, and functioning after hip fracture. J Gerontol A Biol Sci Med Sci 60:80–84PubMed
32.
Zurück zum Zitat Jones G, Nguyen T, Sambrook P, Kelly PJ, Eisman JA (1994) Progressive loss of bone in the femoral neck in elderly people: longitudinal findings from the Dubbo osteoporosis epidemiology study. BMJ 309:691–695PubMed Jones G, Nguyen T, Sambrook P, Kelly PJ, Eisman JA (1994) Progressive loss of bone in the femoral neck in elderly people: longitudinal findings from the Dubbo osteoporosis epidemiology study. BMJ 309:691–695PubMed
33.
Zurück zum Zitat Burger H, de Laet CE, van Daele PL, Weel AE, Witteman JC, Hofman A, Pols HA (1998) Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Am J Epidemiol 147:871–879PubMed Burger H, de Laet CE, van Daele PL, Weel AE, Witteman JC, Hofman A, Pols HA (1998) Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Am J Epidemiol 147:871–879PubMed
34.
Zurück zum Zitat Dennison E, Eastell R, Fall CH, Kellingray S, Wood PJ, Cooper C (1999) Determinants of bone loss in elderly men and women: a prospective population-based study. Osteoporos Int 10:384–391CrossRefPubMed Dennison E, Eastell R, Fall CH, Kellingray S, Wood PJ, Cooper C (1999) Determinants of bone loss in elderly men and women: a prospective population-based study. Osteoporos Int 10:384–391CrossRefPubMed
35.
Zurück zum Zitat Melton LJ 3rd, Atkinson EJ, O’Connor MK, O’Fallon WM, Riggs BL (2000) Determinants of bone loss from the femoral neck in women of different ages. J Bone Miner Res 15:24–31CrossRefPubMed Melton LJ 3rd, Atkinson EJ, O’Connor MK, O’Fallon WM, Riggs BL (2000) Determinants of bone loss from the femoral neck in women of different ages. J Bone Miner Res 15:24–31CrossRefPubMed
36.
Zurück zum Zitat Ensrud KE, Palermo L, Black DM, Cauley J, Jergas M, Orwoll ES, Nevitt MC, Fox KM, Cummings SR (1995) Hip and calcaneal bone loss increase with advancing age: longitudinal results from the study of osteoporotic fractures. J Bone Miner Res 10:1778–1787CrossRefPubMed Ensrud KE, Palermo L, Black DM, Cauley J, Jergas M, Orwoll ES, Nevitt MC, Fox KM, Cummings SR (1995) Hip and calcaneal bone loss increase with advancing age: longitudinal results from the study of osteoporotic fractures. J Bone Miner Res 10:1778–1787CrossRefPubMed
37.
Zurück zum Zitat Karlsson M, Nilsson JA, Sernbo I, Redlund-Johnell I, Johnell O, Obrant KJ (1996) Changes of bone mineral mass and soft tissue composition after hip fracture. Bone 18:19–22CrossRefPubMed Karlsson M, Nilsson JA, Sernbo I, Redlund-Johnell I, Johnell O, Obrant KJ (1996) Changes of bone mineral mass and soft tissue composition after hip fracture. Bone 18:19–22CrossRefPubMed
Metadaten
Titel
Women with hip fracture experience greater loss of geometric strength in the contralateral hip during the year following fracture than age-matched controls
verfasst von
L. Reider
T. J. Beck
M. C. Hochberg
W. G. Hawkes
D. Orwig
J. A. YuYahiro
J. R. Hebel
J. Magaziner
for the Study of Osteoporotic Fractures Research Group
Publikationsdatum
01.05.2010
Verlag
Springer-Verlag
Erschienen in
Osteoporosis International / Ausgabe 5/2010
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-009-1000-4

Weitere Artikel der Ausgabe 5/2010

Osteoporosis International 5/2010 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.