Aims: To investigate the correlation between femoral bone cortical thickness (FBCT) , bone turnover parameters and short-term outcomes in older patients with a hip fracture (HF).
Methods: In 823 consecutive patients admitted with a HF, multidimensional correlation analysis of FBCT (measured at 3 cm [CM3] and 10 cm [CM10] below the lesser trochanter on plain-film pelvic radiograph and categorised into quartiles [Q1 thinnest, Q4 thickest]), serum levels of procollagen type 1 N-terminal propeptide (P1NP), C-terminal telopeptide (CTX), parathyroid hormone (PTH), vitamin D, calcium, phosphate and magnesium has been performed. Outcomes included in-hospital mortality, length of hospital stay (LOS), troponin rise and elevated C-reactive protein (CRP >=100 mg/L).
Results: At both levels (CM3 and CM10), female sex and older age were associated with thinner FBCT. Patients with thinner FBCT showed higher PTH overall (p=0.011), higher serum calcium in males (p=0.042), and higher CTX in females (p=0.048). The low-formation/high-resorption phenotype (P1NP ≤32 µg/L and CTX ≥100 ng/L) was more frequent with thinner FBCT (Q2 71.2% vs Q4 57.7%; p=0.007; OR 1.81). Patients with thinner FBCT more often had prolonged LOS ≥10 days (64.7% in Q3 vs 55.0% in Q4; p=0.045), but other adverse outcomes did not differ across quartiles.
Conclusions: FBCT, a sex and age-dependent index, is associated with factors essential for bone metabolism, reflects imbalance in bone turnover and some post-fracture outcomes; this simple marker may help recognise skeletal fragility.