Risk prediction of second hip fracture by bone and muscle density of the hip varies with time after first hip fracture: A prospective cohort study

Ling Wang; Minghui Yang; Yufeng Ge; Yandong Liu; Gang Wang; Yongbin Su; Zhe Guo; Lu Yin; Pengju Huang; Jian Geng; Glen M Blake; Bo He; Shiwen Zhu; Xiaoguang Cheng; Xinbao Wu; Hannu T Aro; Annegreet Vlug; Klaus Engelke

doi:10.1016/j.bonr.2023.101732

Risk prediction of second hip fracture by bone and muscle density of the hip varies with time after first hip fracture: A prospective cohort study

Bone Rep. 2023 Dec 22:20:101732. doi: 10.1016/j.bonr.2023.101732. eCollection 2024 Mar.

Authors

Ling Wang¹, Minghui Yang², Yufeng Ge², Yandong Liu¹, Gang Wang³, Yongbin Su¹, Zhe Guo¹, Lu Yin⁴, Pengju Huang¹, Jian Geng¹, Glen M Blake⁵, Bo He⁶, Shiwen Zhu², Xiaoguang Cheng¹, Xinbao Wu², Hannu T Aro⁷, Annegreet Vlug⁸, Klaus Engelke^{9

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Affiliations

¹ Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
² Departments of Traumatic Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
³ Department of Radiology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China.
⁴ Information Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Fuwai Hospital, Beijing 100037, China.
⁵ School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom.
⁶ Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
⁷ Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland.
⁸ Center for Bone Quality, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
⁹ Department of Medicine 3, FAU University Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany.
¹⁰ Institute of Medical Physics, University of Erlangen, Erlangen, Germany.

Abstract

Purpose: Predictors of 'imminent' risk of second hip fracture are unknown. The aims of the study were to explore strength of hip areal bone mineral density (aBMD), and muscle area and density for predicting second hip fracture at different time intervals.

Methods: Data of the Chinese Second Hip Fracture Evaluation were analyzed, a longitudinal study to evaluate the risk of second hip fracture (of the contralateral hip) by using CT images obtained immediately after first hip fracture. Muscle cross-sectional area and density were measured of the gluteus maximus (G.MaxM) and gluteus medius and minimus (G.Med/MinM) and aBMD of the proximal femur at the contralateral unfractured side. Patients were followed up for a median time of 4.5 years. Separate Cox models were used to predict second hip fracture risk at different time intervals after first event adjusted for age, sex, BMI and diabetes.

Results: The mean age of subjects with imminent (within 1st or 2nd year) second hip fracture was 79.80 ± 5.16 and 81.56 ± 3.64 years. In the 1st year after the first hip fracture, femoral neck (FN) aBMD predicted second hip fracture (HR 5.88; 95 % CI, 1.32-26.09). In the remaining years of follow-up after 2nd year, muscle density predicted second hip fracture (G.MaxM HR 2.13; 95 % CI, 1.25-3.65,G.Med/MinM HR 2.10; 95 % CI, 1.32-3.34).

Conclusions: Our results show that femoral neck aBMD is an important predictor for second hip fracture within the first year and therefore suggest supports the importance concept of early and rapid-acting bone-active drugs to increase hip BMD. In addition, the importance of muscle density predicting second hip fracture after the second year suggest post hip fracture rehabilitation and exercise programs could also be important to reduce muscle fatty infiltration.

Keywords: Bone mineral density; Muscle density; Risk predictor; Second hip fracture.