Prevalence, Clinical Implication, and Cause of Spine Hip Discordance in Elderly Patients with Fragility Hip Fracture
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Background: Spine-hip discordance (SHD) increases fracture risk. However, its preva- lence and clinical implications have not been investigated in patients with hip fractures. This study determined the prevalence and association of SHD with mortality and inves- tigated the cause of SHD in patients with hip fractures. Methods: This study included patients admitted for fragility hip fractures between 2011 and 2020. All patients under- went dual energy X-ray absorptiometry and anteroposterior and lateral views of the lumbosacral spine during admission. Data on demographics, diagnosis, American Soci- ety of Anesthesiologists score, and mortality were collected. A T-score difference of more than 1.5 between L1-4 and the femur neck was considered discordant, and 3 groups (lumbar low [LL] discordance, no discordance [ND], and femur neck low [FL] discordance) were compared. In the discordance group, lumbar radiographs were reviewed to deter- mine the cause of discordance. Results: Among 1,220 eligible patients, 130 were ex- cluded due to patient refusal or bilateral hip implantation; therefore, this study included 1,090 patients (271 male and 819 female). The prevalence of LL, ND, and FL was 4.4%, 66.4% and 29.2% in men and 3.9%, 76.1%, and 20.0% women. Mortality was not associ- ated with discordance. The most common causes of discordance were physiological in the LL group and pathological in the FL group for both sexes. Conclusions: Patients with hip fractures showed lower rates of ND and higher rates of FL compared to the general population. True discordance should be carefully judged for pathological and artifact reasons. The clinical implications of SHD require further investigation.
Abstract
Background: Spine-hip discordance (SHD) increases fracture risk. However, its preva- lence and clinical implications have not been investigated in patients with hip fractures. This study determined the prevalence and association of SHD with mortality and inves- tigated the cause of SHD in patients with hip fractures. Methods: This study included patients admitted for fragility hip fractures between 2011 and 2020. All patients under- went dual energy X-ray absorptiometry and anteroposterior and lateral views of the lumbosacral spine during admission. Data on demographics, diagnosis, American Soci- ety of Anesthesiologists score, and mortality were collected. A T-score difference of more than 1.5 between L1-4 and the femur neck was considered discordant, and 3 groups (lumbar low [LL] discordance, no discordance [ND], and femur neck low [FL] discordance) were compared. In the discordance group, lumbar radiographs were reviewed to deter- mine the cause of discordance. Results: Among 1,220 eligible patients, 130 were ex- cluded due to patient refusal or bilateral hip implantation; therefore, this study included 1,090 patients (271 male and 819 female). The prevalence of LL, ND, and FL was 4.4%, 66.4% and 29.2% in men and 3.9%, 76.1%, and 20.0% women. Mortality was not associ- ated with discordance. The most common causes of discordance were physiological in the LL group and pathological in the FL group for both sexes. Conclusions: Patients with hip fractures showed lower rates of ND and higher rates of FL compared to the general population. True discordance should be carefully judged for pathological and artifact reasons. The clinical implications of SHD require further investigation.
참고문헌 (16)
- Cauley JA, "Public health impact of osteoporosis", J Gerontol A Biol Sci Med Sci, 68, pp.1243~1251 (2013)[DOI]
- Compston JE, "Osteoporosis", Lancet, 393, pp.364~376 (2019)[DOI]
- Woodson G, "Dual X-ray absorptiometry T-score concordance and discordance between the hip and spine measurement sites", J Clin Densitom, 3, pp.319~324 (2000)[DOI]
- Faulkner KG, "Discordance in patient classification using T-scores", J Clin Densitom, 2, pp.343~350 (1999)[DOI]
- Johansson H, "Impact of femoral neck and lumbar spine BMD discordances on FRAX probabilities in women : a meta-analysis of international cohorts", Calcif Tissue Int, 95, pp.428~435 (2014)[DOI]
- Hong AR, "Metabolic characteristics of subjects with spine-femur bone mineral density discordances : the Korean National Health and Nutrition Examination Survey(KNHANES 2008-2011)", J Bone Miner Metab, 37, pp.835~843 (2019)[DOI]
- Leslie WD, "Spine-hip discordance and fracture risk assessment : a physician-friendly FRAX enhancement", Osteoporos Int, 22, pp.839~847 (2011)[DOI]
- Leslie WD, "Impact of spine-hip discordance on fracture risk assessment and treatment qualification in Canada : the Manitoba BMD registry", Arch Osteoporos, 15, pp.85~ (2020)[DOI]
- Melton LJ, 3rd, "Hip fractures: A worldwide problem today and tomorrow", Bone, 14(Suppl 1), pp.S1~S8 (1993)[DOI]
- El Maghraoui A, "Prevalence and risk factors of discordance in diagnosis of osteoporosis using spine and hip bone densitometry", Ann Rheum Dis, 66, pp.271~272 (2007)[DOI]
- Seok H, "High prevalence of spine–femur bone mineral density discordance and comparison of vertebral fracture risk assessment using femoral neck and lumbar spine bone density in Korean patients", J Bone Miner Metab, 32, pp.405~410 (2014)[DOI]
- Chan CY, "Prevalence and factors of T-score discordance between hip and spine among middle-aged and elderly Malaysians", Arch Osteoporos, 15, pp.142~ (2020)[DOI]
- Lauritzen JB, "Risk factors for hip fractures. A review", Dan Med Bull, 40, pp.479~485 (1993)
- Rivadeneira F, "Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability : the Rotterdam Study", J Bone Miner Res, 22, pp.1781~1790 (2007)[DOI]
- Paccou J, "Bone microarchitecture in men and women with diabetes : The importance of cortical porosity", Calcif Tissue Int, 98, pp.465~473 (2016)[DOI]
- Yu EW, "Defects in cortical microarchitecture among African-American women with type 2 diabetes", Osteoporos Int, 26, pp.673~679 (2015)[DOI]