Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry · 2026
Lumbar spine-hip T-score discordance in atypical femoral fracture: An exploratory systematic review and meta-analysis.
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Lim Dong-Ju, Sung Ha-Rim, Kim Dong-Yong
Аннотация
OBJECTIVE: Atypical femoral fracture is rare. We evaluated whether lumbar spine-hip T-score discordance, a dual-energy X-ray absorptiometry-derived densitometric phenotype, is enriched among atypical femoral fracture cases compared with controls.
METHODS: PubMed, Embase, Cochrane Library, Web of Science, KoreaMed, and RISS were searched from inception to December 31, 2025. Comparative studies of adults with American Society for Bone and Mineral Research-defined atypical femoral fracture that reported lumbar spine and femoral neck T-scores with discordance data were included. Study-level grouped 2 × 2 data were pooled using random-effects models. T-score timing was extracted; it was not uniformly reported. Certainty was assessed using GRADE.
RESULTS: Three Korean retrospective case-control studies including 160 atypical femoral fracture cases and 513 controls were eligible. Discordance definitions were non-equivalent: World Health Organization category mismatch, Delta T-score ≥1.0, and Delta T-score ≥1.5. Discordance prevalence was 103/160 (64.4%) in cases and 170/513 (33.1%) in controls. The pooled random-effects odds ratio was 4.16 (95% CI 2.30-7.52; I2 56.9%). The low-lumbar-spine pattern showed greater case enrichment (odds ratio 7.76; 95% CI 1.70-35.51; I2 86.8%). GRADE certainty was Very Low.
CONCLUSIONS: Across three Korean studies with non-equivalent discordance definitions and heterogeneous comparators, lumbar spine-hip T-score discordance was more frequent among atypical femoral fracture cases. This exploratory, hypothesis-generating association should not be interpreted as a diagnostic threshold or individual-level prediction. Because atypical femoral fracture is rare and case-control sampling does not represent population prevalence, odds ratios cannot yield valid positive or negative predictive values.
METHODS: PubMed, Embase, Cochrane Library, Web of Science, KoreaMed, and RISS were searched from inception to December 31, 2025. Comparative studies of adults with American Society for Bone and Mineral Research-defined atypical femoral fracture that reported lumbar spine and femoral neck T-scores with discordance data were included. Study-level grouped 2 × 2 data were pooled using random-effects models. T-score timing was extracted; it was not uniformly reported. Certainty was assessed using GRADE.
RESULTS: Three Korean retrospective case-control studies including 160 atypical femoral fracture cases and 513 controls were eligible. Discordance definitions were non-equivalent: World Health Organization category mismatch, Delta T-score ≥1.0, and Delta T-score ≥1.5. Discordance prevalence was 103/160 (64.4%) in cases and 170/513 (33.1%) in controls. The pooled random-effects odds ratio was 4.16 (95% CI 2.30-7.52; I2 56.9%). The low-lumbar-spine pattern showed greater case enrichment (odds ratio 7.76; 95% CI 1.70-35.51; I2 86.8%). GRADE certainty was Very Low.
CONCLUSIONS: Across three Korean studies with non-equivalent discordance definitions and heterogeneous comparators, lumbar spine-hip T-score discordance was more frequent among atypical femoral fracture cases. This exploratory, hypothesis-generating association should not be interpreted as a diagnostic threshold or individual-level prediction. Because atypical femoral fracture is rare and case-control sampling does not represent population prevalence, odds ratios cannot yield valid positive or negative predictive values.