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BMD T-score discriminates trochanteric fractures from unfractured controls, whereas geometry discriminates cervical fracture cases from unfractured controls of similar BMD
Osteoporosis International, 10/02/09

Pulkkinen P et al. – The study suggests that the risk of trochanteric fractures could be discriminated based on a BMD T-score <?2.5 criterion, whereas cervical fracture cases would remain under-diagnosed if solely using this criterion. Instead, geometrical risk factors are able to discriminate cervical fracture cases even among individuals with T-score >?2.5. For cervical and trochanteric fractures combined, BMD and geometric measures independently contributed to hip fracture discrimination. Our data support changing from T-score <?2.5 to a more comprehensive assessment of hip fracture etiology, in which fracture type is also taken into account.

• Postmenopausal females with non-pathologic cervical (n?=?39) or trochanteric (n?=?18) hip fracture (mean age 74.2 years)
• 40 age-matched controls
• BMD measured at femoral neck, and femoral neck axis length, femoral neck and shaft cortex thicknesses (FNC and FSC), and femoral neck-shaft angle (NSA) measured from radiographs

• BMD T-score threshold of ?2.5 was able to discriminate trochanteric fractures from controls
• 17 out of 18 trochanteric fractures occurred in individuals with T-score ≤ ?2.5
• T-score criterion not able to discriminate cervical fractures
• 20 of these fractures (51.3%) occurred in individuals with BMD in osteoporotic range and 19 (48.7%) in individuals with T-score >?2.5
• Within these non-osteoporotic cervical fracture patients (N?=?19) and non-osteoporotic controls (N?=?35), 83.3% classified correctly based on a model including NSA and FNC (p?

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