Associations of Quantitative and Qualitative Muscle Parameters With Second Hip Fracture Risk in Older Women: A Prospective Cohort Study

• Published in: JBMR plus Vol. 7; no. 12; pp. e10834 - n/a
• Main Authors: Zhang, Wenshuang, Ge, Yufeng, Liu, Yandong, Yuan, Yi, Geng, Jian, Zhou, Fengyun, Huang, Pengju, Shi, Jia, Ma, Kangkang, Cheng, Zitong, Blake, Glen M., Yang, Minghui, Wu, Xinbao, Cheng, Xiaoguang, Wang, Ling
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.12.2023; Oxford University Press
• Subjects: Absorptiometry; Bone density; Bone mineral density; Cardiovascular disease; Classification; Computed tomography; ELDERLY FEMALES; Females; Femur; Fractures; GOUTALLIER CLASSIFICATION; Hip; Hip joint; Medical imaging; MUSCLE DENSITY; Muscles; RISK PREDICTOR; SECOND HIP FRACTURE; Statistical analysis; Womens health; SECOND HIP FRACTURE; GOUTALLIER CLASSIFICATION; ELDERLY FEMALES; RISK PREDICTOR; MUSCLE DENSITY
• ISSN: 2473-4039; 2473-4039
• DOI: 10.1002/jbm4.10834

ABSTRACT Older women with a first hip fracture exhibit heightened susceptibility and incidence of second fracture and potentially severe consequences. This prospective study was to compare the predictive power of qualitative and quantitative muscle parameters for a second hip fracture in older women with a first hip fracture. A total of 206 subjects were recruited from the longitudinal Chinese Second Hip Fracture Evaluation study. Hip computed tomography (CT) scans were obtained immediately after the first fracture. Muscle fat infiltration was assessed according to the Goutallier classification qualitatively. Quantitative parameters included cross‐sectional area and density of gluteus maximus (G.MaxM) and gluteus medius and minimus (G.Med/MinM) muscles. CT X‐ray absorptiometry was used to measure the areal bone mineral density (aBMD) of the contralateral femur. Cox proportional hazards models were used to compute hazard ratios (HR) of second hip fracture risk. The mean age of subjects was 74.9 (±9.5) years at baseline. After 4.5 years, 35 had a second hip fracture, 153 without a second hip fracture, and 18 died. Except for the combined G.MinM Goutallier grade 3 and 4 groups before adjustment for covariates (HR = 5.83; 95% confidence interval [CI] 1.49–22.83), there were no significant HRs for qualitative classification to predict a second hip fracture. Among quantitative metrics, after adjustment for covariates, G.Med/MinM density was significant in the original (HR = 1.44; CI 1.02–2.04) and competing risk analyses (HR = 1.46; CI 1.02–2.07). After additional adjustment for femoral neck (FN) aBMD, G.Med/MinM density remained borderline significant for predicting a second hip fracture in competing risk analysis (HR = 1.43; CI 0.99–2.06; p = 0.057). Our study revealed that Goutallier classification was less effective than quantitative muscle metrics for predicting hip second fracture in this elderly female cohort. After adjustment for FN aBMD, G.Med/MinM density is a borderline independent predictor of second hip fracture risk. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. The Goutallier classification was less effective than quantitative muscle metrics associated with second hip fracture risk in the female low‐energy hip fracture cohort. After adjustment for FN BMD, G.Med/MinM density was a borderline independent predictor for a second hip fracture in elderly females with an initial hip fracture. These findings provide valuable insights into the critical role of integrating muscle quantitative assessments into routine clinical evaluations.