Predictive value of a prediction system based on bone mineral density and proximal femoral imaging indexes for hip fracture risk in osteoporotic patients.

OBJECTIVE

To establish a nomogram model based on bone mineral density (BMD), and radiographic indexes of the proximal femur for predicting hip fracture (HF) risk in osteoporosis patients.

METHODS

A total of 120 patients who underwent both orthopedic and lateral view examination from February 2022 to January 2024 were retrospectively collected and screened. They were divided into fracture (n=60) and non-fracture groups (n=60). The recorded parameters included sex, age, femoral intertrochanteric BMD, femoral cortical thickness (FCT), femoral neck length (FNL), hip axis length (HAL) and the hip offset distance (FO). Univariate and multivariate logistic regression analysis were conducted to determine the risk factors for hip fracture in osteoporotic patients. A nomogram model was subsequently constructed. Furthermore, to validate the model's clinical utility, an additional 1-year follow-up was conducted on 40 randomly selected patients.

RESULTS

The fracture group had significantly longer HAL, thinner FCT, and reduced femoral intertrochanteric BMD than the non-fracture group (all P < 0.001). The HAL, FCT and intertrochanteric BMD were the independent risk factors for the hip fracture. The model accurately predicted hip fracture in osteoporosis patients, with an Area under the curve (AUC) of 0.93, sensitivity of 0.86 and specificity of 0.83. During a one-year follow-up of 40 osteoporosis patients, 6 fractures were observed, 5 with a prediction model score > 100 and 1 with a score < 100, further validating the reliability of the predictive model.

CONCLUSION

The nomogram model has a better prediction ability of hip fracture risk in osteoporosis patients. It provides a theoretical basis for the individualization of the diagnosis and treatment for elderly patients.