NEW YORK (Reuters Health)—Various image analysis techniques show sex-specific patterns of bone deterioration at the hip, suggesting that men and women should be assessed differently for hip fracture risk, researchers say.
“One major contribution of this work is the integration of data-driven computational anatomy approaches, which showed that proximal femur fragility linked to fracture seems to be localized rather than uniform in both men and women,” Elisa Marques, PhD, tells Reuters Health by email.
“In that regard, the incorporation of CT and computational anatomy techniques might be quite useful for research and clinical efforts, as well as for designing targeted interventions and properly assessing their success,” said Dr. Marques, who was a postdoctoral fellow at the U.S. National Institute on Aging during the study and now is at the University of Maia in Portugal.
Dr. Marques and colleagues analyzed imaging data from 334 people (60% women) who had a hip fracture and 1,047 controls (54% women), all with a mean age of 77 and all participants in the AGES-Reykjavic study of Icelandic men and women.
Baseline (before hip fracture) computed tomography scans of the hip were analyzed using voxel-based morphometry, tensor-based morphometry, and surface-based statistical parametric mapping to assess the spatial distribution of volumetric bone mineral density (vBMD), internal structure, and cortical bone properties of the proximal femur: thickness, vBMD and trabecular vBMD adjacent to the endosteal surface.
As reported online May 17 in Bone, in both men and women, the superior aspect of the femoral neck and the trochanteric region—except for cortical bone thickness—were consistently associated with incident hip fracture.1
Differences in bone properties between non-cases and incident hip fracture cases followed similar trends in both men and women, were located at compatible regions, and showed heterogeneity in the spatial distribution of their magnitude, with focal regions showing greater differences.
Most of the regions with a significant interaction between fracture group and sex showed differences of greater magnitude in men than in women between non-cases and hip fracture cases, with different spatial distributions for all bone properties, with the exception of cortical bone thickness.
Although most of these regions showed better bone quality in male than in female cases, female cases showed higher vBMD in the principal compressive group and higher endotrabecular vBMD at several regions, including the anterior, posterior, and lateral aspects of the proximal femur.
“These findings indicate the value of these image analysis techniques by providing unique information about the specific patterns of bone deterioration associated with incident hip fracture and their sex differences, highlighting the importance of looking to men and women separately in the assessment of hip fracture risk,” the authors conclude.