Comparative evaluation of radiographic morphologic parameters for predicting subsequent contralateral fragility hip fracture

Purpose: Subsequent contralateral fragility hip fracture (SCHF) is one of the most serious conditions in osteoporotic patients due to high morbidity and mortality. This study aimed to investigate the predictive ability of radiographic morphologic parameters for SCHF in patients diagnosed with unilateral fragility hip fractures.

Methods: We conducted a retrospective observational study of unilateral fragility hip fracture patients between April 2016 and December 2021. Radiographic morphologic parameters, including canal-calcar ratio (CCR), cortical thickness index (CTI), canal-flare index (CFI), and morphological cortical index (MCI), were measured from patients' contralateral proximal femur anteroposterior radiographic study to evaluate the risk of SCHF. Multivariable logistic regression analysis was employed to determine the adjusted predictive ability of the radiographic morphologic parameters.

Results: Of the included 459 patients, 49 (10.7%) experienced SCHF. All radiographic morphologic parameters demonstrated excellent performance in predicting SCHF. After being adjusted by patients' age, BMI, visual impairment status, and dementia, CTI revealed the greatest adjusted odds ratio for SCHF of 35.05 (95% CI 7.34 to 167.39, p < 0.001) followed by CFI (OR = 13.32; 95% CI 6.50 to 27.32, p < 0.001), MCI (OR = 5.60; 95% CI 2.84 to 11.04, p < 0.001), and CCR (OR = 4.50; 95% CI 2.32 to 8.72, p < 0.001).

Conclusion: CTI demonstrated the greatest odds ratio for SCHF, followed by CFI, MCI, and CCR. These radiographic morphologic parameters could provide a preliminary prediction for SCHF in elderly patients presenting with unilateral fragility hip fractures.