J Bone Metab 2013;20:11-15 http://dx.doi.org/10.11005/jbm.2013.20.1.11 pISSN 2287-6375 eISSN 2287-7029 Original Article Analysis of Clinical Features of Hip Fracture Patients with or without Prior Osteoporotic Spinal Compression Fractures Gang Deuk Kim1, Yeung Jin Kim2, Soo Uk Chae2, Deok Hwa Choi3 Departments of 1Radiology, 2Orthopeadic Surgery, and 3Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University Hospital, Iksan, Korea Corresponding author Background: To analyze and compare the clinical characteristics including bone mineral Soo Uk Chae density (BMD) in a group who had operation of hip fracture with or without prior osteo- Department of Orthopedic Surgery, School of porotic spinal compression fractures. Methods: Two hundred forty patients who had Medicine, Wonkwang University, 27 undergone operation of hip fractures were evaluated, 127 patients who had with prior Uiryowon-ro, Gunsan 573-713, Korea osteoporotic spinal compression fractures were in group I, and 113 patients without pri- Tel: +82-63-472-5100 or spinal fractures were in group II. In each group, we measured age, gender, body mass 2 3 Fax: +82-63-472-5688 index (BMI, kg/m ), BMD (mg/cm ), type of hip fractures, concomitant diseases, presence E-mail: [email protected] of secondary hip fracture and history of percutaneous vertebroplasty. Results: The mean age of group I was 79.4 years (male/female: 28/99) and that of group II was 77.6 years 2 Received: January 11, 2013 (male/female: 37/76). The mean BMI of group I was 21.3 kg/m and that in group II was 2 3 Revised: April 10, 2013 22.0 kg/m . The mean BMD and T-score of group I were 41.1 mg/cm and -4.45 and those 3 Accepted: April 10, 2013 in group II were 51.0 mg/cm and -4.17 (P<0.05). The numbers of patients of neck and intertrochanter fracture of group I were 31 and 96 patients and those in group II were 61 No potential conflict of interest relevant to this and 52 patients. Sixty in group I and 45 in group II patients had concomitant diseases. article was reported. Thirteen patients had undergone percutaneous vertebroplasty and 18 patients (7.5%) had second hip fractures. Conclusions: The hip fracture patients who had with prior os- This paper was supported by Wonkwang University teoporotic spinal compression fractures had lower BMD compared to the hip fracture in 2013. patients without previous spinal compression fractures. Key Words: Bone density, Hip fractures, Spinal fractures INTRODUCTION Recent studies reported increasing risks of hip, spine, and others among people who had previous clinically diagnosed fractures, or radiographic evidence of ver- tebral fractures.[1,2] Also, spinal radiographs identifying of prevalent vertebral Copyright © 2013 The Korean Society for Bone and Mineral Research deformities may be useful additional measurement to classify further a women’s This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Li- risk of future fracture.[1] Women with preexisting vertebral fractures had approxi- cense (http://creativecommons.org/licenses/by-nc/3.0/) mately 4 times higher risk of subsequent vertebral fractures and 2.3 times greater which permits unrestricted non-commercial use, distribu- tion, and reproduction in any medium, provided the original risk of subsequent hip fractures than those without prior fractures.[2] work is properly cited. Percutaneous vertebroplasty is one of the most commonly performed proce- dures for symptomatic osteoporotic spinal fractures.[3,4] But, subsequent fracture of spine is a potential complication of vertebroplasty.[3,5] There are many reports http://e-jbm.org/ 11 Gang Deuk Kim, et al. of subsequent vertebral fracture while there are only a few computed tomography (P-QCT; Somatom sensation 16, Si- reports of non-vertebral fracture, especially, hip fractures af- mens, Erlangen, Germany) of thoracolumbar vertebrae ter percutanous vertebroplasty in osteoporotic spinal com­­ that enables separate analyses of cortical, trabecular and pression fracture. This present study aim to analyze and total bone density including T-score. compare the clinical characteristics of bone mineral density Quantitative variables (age, BMI, BMD and T-score) were (BMD) in a group of hip fracture patients whether or not pri- compared between groups by an independent T-test and or osteoporotic spinal compression fractures by cohort ret- difference in the categorical variables (sex, hip fracture rospective study. Additionally, whether or not of secondary type and concomitant disease) were compared using the hip fracture and history of percutaneous vertebroplasty in chi-square test. The Mann-Whitney U test for continuous both groups were investigated. variables was used. SPSS version 20.0 (SPSS Inc., Chicago, IL, USA) was used for the statistical analyses. A P value of METHODS less than 0.05 was considered statistically significant. We reviewed 240 patients over 65 years of age among RESULTS 436 cases who had undergone operation of intertrochan- teric and neck of hip fractures in one hospital by retrospec- The mean age of group I was 79.4 years (range, 65 to 95 tive study from June 2006 to June 2012. We excluded pa- years) and group II was 77.6 years (range, 65 to 93 years). The tients who had hip fracture by high velocity injury such as mean BMI of group I was 21.32±4.2 kg/m2 (mean weight/ a motor vehicle accident or falling down from height, those mean height: 51.8 kg/155.9 cm) and group II was 22.03± with under 65 years of age, unexamined BMD, and previ- 3.4 kg/m2 (mean weight/ mean height: 55.9 kg/158.9 cm). ous spine fusion operation. We checked BMD and simple The mean BMD and T-score of group I were 41.12±21.9 thoracolumbar radiograph of whole patients at the time of mg/cm3 and -4.45±0.8 and those in group II were 51.00± injury. The patients were divided into prior osteoporotic 20.3 mg/cm3 and -4.17±0.7. The age of group I was rela- spinal compression fractures in group I (127 patients, male/ tively older than those of group II (P=0.124), but the BMIs female: 28/99) and without compression fractures in group had no significant difference between groups (P=0.293). II (113 patients, male/female: 37/76). In each group, we The BMD of group I was significantly lower than those of measured age and gender, body mass index (BMI, kg/m2) group II (P<0.001). Also, the T-score of group I was signifi- with weight and height, type of hip fractures, concomitant cantly lower than those of group II (P=0.007) (Table 1). The diseases, and presence of secondary hip fracture and un- numbers of patient of neck and intertrochanter fracture of dergone percutaneous vertebroplasty. The fractures were group I were 31 (24.4%) and 96 (75.6%) patients and those classified as hip fractures in intertrochanteric and femoral neck fractures. The definition of second hip fracture was Table 1. Demographic data patients who have suffered a hip fracture with a subse- Hip Fx with Hip Fx without quent fracture of the contralateral hip. The included con- prior spine Fx. prior spine Fx P value (n=127) (n=113) comitant diseases were hypertension, diabetes mellitus, Age (yr) 79.38±6.4 77.55±6.9 0.124 cardiac disease, and senile dementia. Sex (M/F) 28/99 37/76 0.080 Assessment of prior radiographic vertebral fractures has BMI (kg/m2) 21.32±4.2 22.03±3.4 0.293 been by a radiologist and two orthopedic surgeons. Six BMD (mg/cm3) 41.12±21.9 51.00±20.3 <0.001 points digitations on each vertebral body of the thoracic T-score -4.45±0.8 -4.17±0.7 0.007 and lumbar lateral radiograph for quantitative morphome- Concomitant Ds (n) 67 (52.8%) 68 (60.1%) 0.297 try were done as described previously, so that the anterior, Intertrochanteric Fx (n) 96 (75.6%) 52 (46.0%) <0.001 middle, and posterior heights could be accurately mea- Neck Fx (n) 31 (24.4%) 61 (54.0%) <0.001 sured.[6,7] Baseline prevalent deformities were defined us- Data are expressed as means±SD. Statistically significant at the 0.05 level. ing a modified Melton/Eastell vertebral height ratio crite- Fx, fracture; BMI, body mass index; BMD, bone mineral density; Ds, dis- ria.[6] BMD was measured utilizing peripheral-quantitative ease. 12 http://e-jbm.org/ http://dx.doi.org/10.11005/jbm.2013.20.1.11 Hip Fracture with or without Prior Spinal Fractures Table 2. Comparison of between hip fracture with or without verte- Table 3. Comparison of between unilateral hip fracture and second broplasty hip fracture Hip Fx with Hip Fx without Unilateral hip Second hip vertebroplasty vertebroplasty P value fracture fracture P value (n=13) (n=114) (n=222) (n=18) Age (yr) 78.50±6.5 79.52±6.4 0.535 Age (yr) 78.18±6.6 82.72±6.7 0.006 Sex (M/F) 2/11 26/88 1 Sex (M/F) 59/163 6/12 0.583 BMI (kg/m2) 21.25±2.8 21.32±6.4 0.963 BMI (kg/m2) 21.57±3.9 22.35±2.2 0.586 BMD (mg/cm3) 42.98±19.1 40.18±22.4 0.700 BMD (mg/cm3) 46.14±22.1 41.18±16.4 0.353 T-score -4.38±0.6 -4.46±0.8 0.694 T-score -4.30±0.8 -4.53±0.4 0.081 Concomitant Ds (n) 6 47 0.308 Concomitant Ds (n) 98 7 0.806 Data are expressed as means±SD.