Association of hip osteoporosis with pattern of proximal femoral fractures

Introduction: Proximal femoral fractures account for a large number of hospitalization cases among the elderly patients. The proximal femoral fractures pattern based on intra-articular or extra-articular could affect the treatment options and induce several complications. The aim of this study is to evaluate the relationship between the severity of osteoporosis and pattern of proximal femoral fractures among elderly patients. Methods: In this cross-sectional study, 83 patients over than 65 years old were enrolled from 2014 to 2018 in the orthopedic department of Urmia University of Medical Sciences, Urmia, Iran. Bone mineral density (BMD) was determined by dual energy x-ray absorptiometry (DXA) at the time of hospitalization. Vitamin D level was also measured. Finally, the mortality rate was determined in 12-month follow-up after the operation. Results: In this study, 83 patients with proximal femoral fractures including 60 cases (72.3%) with extra-articular fractures and 23 cases (27.7%) with intra-articular fractures were investigated. The mean vitamin D level of these two groups [patients with intra-articular fracture (34.4 ± 24.7 nmol/l) and extra-articular fracture (11.3 ± 5.4 nmol/l)] was significantly different (P = 0.020). A significant difference was also observed in the bone densities (based on T-score) of these two groups (P < 0.001). The patients’ mortality rate was significantly different and it was higher in patients with extra-articular fracture (23.0%) compared to those with intra-articular fracture (17.3%) (P = 0.020). Conclusion: In the case of elderly patients, the hip bone density and vitamin D levels play a decisive role in predicting the pattern of proximal femoral fractures. It was also associated with increased mortality among the elderly patients.