Women with hip fracture experience greater loss of geometric strength in the contralateral hip during the year following fracture than age-matched controls

Summary This study examined femur geometry underlying previously observed decline in BMD of the contralateral hip in older women the year following hip fracture compared to non-fractured controls. Compared to controls, these women experienced a greater decline in indices of bone structural strength, potentially increasing the risk of a second fracture. Introduction This study examined the femur geometry underlying previously observed decline in BMD of the contralateral hip in the year following hip fracture compared to non-fractured controls. Methods Geometry was derived from dual-energy X-ray absorptiometry scan images using hip structural analysis from women in the third cohort of the Baltimore Hip Studies and from women in the Study of Osteoporotic Fractures. Change in BMD, section modulus (SM), cross-sectional area (CSA), outer diameter, and buckling ratio (BR) at the narrow neck (NN), intertrochanteric (IT), and shaft (S) regions of the hip were compared. Results Wider bones and reduced CSA underlie the significantly lower BMD observed in women who fractured their hip resulting in more fragile bones expressed by a lower SM and higher BR. Compared to controls, these women experienced a significantly greater decline in CSA (−2.3% vs. −0.2%NN, −3.2% vs. −0.5%IT), SM (−2.1% vs. −0.2%NN, −3.9% vs. −0.6%IT), and BMD (−3.0% vs. −0.8%NN, −3.3% vs. −0.6%IT, −2.3% vs. −0.2%S) and a greater increase in BR (5.0% vs. 2.1%NN, 6.0% vs. 1.3%IT, 4.4% vs. 1.0%S) and shaft outer diameter (0.9% vs. 0.1%). Conclusion The contralateral femur continued to weaken during the year following fracture, potentially increasing the risk of a second fracture.