Bone density distribution and gender dominate femoral neck fracture risk predictors

Objective. To determine whether regional characteristics of the proximal fe mur could discriminate between a group of patients who had just sustained a first low-trauma femoral neck fracture (n=50) from a group of healthy volu nteers (n=123). Design. The application of an integral bone measurement (dual-energy X-ray absorptiometry) in conjunction with a volumetric cancellous bone density me asurement (quantitative computed tomography) to the proximal femur in vivo provided an estimate of the contribution of the spatial distribution of bon e density to hip fracture risk prediction. Results. The primary finding of this study was a significant difference bet ween male and female hip fracture risk predictor variables. In men with fem oral neck fracture, a significant decrease in bone density throughout the p roximal femur was observed. In women with femoral neck fracture, a combinat ion of local bone deficits (significant decrease in cancellous bone at the site of fracture, and a decrease in cortical bone at the site of impact) an d significantly larger proximal femur dimensions (femoral neck and head wid ths) was evident. Conclusions. These results imply that effective hip fracture prevention str ategies may require separate approaches for men and women. Screening progra ms for diminished bone density at the proximal femur have proved effective in previous studies. An approach which includes examining these local bone characteristics may further improve our ability to accurately determine hip fracture risk in vivo.