Femoral Arterial Calcification, Atherogenic Index of Plasma, and 1-Year Mortality After Hip Fracture: A Retrospective Cohort Study.

Background and

Objectives

Femoral arterial calcification (FAC) on routine hip radiographs may provide opportunistic vascular information within orthogeriatric assessment. We evaluated the associations of FAC and the Atherogenic Index of Plasma (AIP) with 1-year mortality after hip-fracture surgery. Materials and

Methods

This retrospective single-centre cohort included 229 patients aged 65 years or older. FAC was graded from 0 to 3 on preoperative radiographs using an exploratory semiquantitative classification. AIP was calculated as log10(TG/HDL-C). Logistic regression and complementary survival analyses were partially adjusted for age, sex, FAC, and AIP. Incremental discrimination was assessed using nested age + sex, age + sex + FAC, and age + sex + FAC + AIP models.

Results

Thirty-eight patients (16.6%) died within 1 year. Interobserver agreement for FAC grading was almost perfect (κ = 0.87). Each one-grade increase in FAC was associated with mortality in the partially adjusted logistic (OR = 1.44, 95% CI 1.09-1.91) and Cox models (HR = 1.36, 95% CI 1.07-1.73). AIP was not significantly associated with mortality. AUCs were 0.726 for age + sex, 0.757 for age + sex + FAC, and 0.761 for age + sex + FAC + AIP; neither incremental increase was significant.

Conclusions

Radiographic FAC was associated with 1-year mortality but did not demonstrate significant incremental discrimination beyond age and sex. FAC may serve as an opportunistic marker within multidisciplinary orthogeriatric assessment, not as a stand-alone prognostic tool. AIP findings remain inconclusive because sampling occurred during acute admission without standardised fasting. Prospective multicentre validation with comprehensive geriatric covariates is required.