Loss of bone mineral of the hip assessed by DEXA following tibial shaft fractures

We measured prospectively early changes (0–6 months) in bone mineral of the hip, the lumbar spine, and the tibia following tibial shaft fractures (n = 12), and in a cross-sectional study we evaluated the maximal amount of bone loss possible at the hip and tibia following long-term (average 3 years) impaired limb function as a consequence of complicated tibial shaft fractures [delayed union or nonunion (n = 7), chronic osteomyelitis (n = 5), decreased limb length (n = 1), or bone defect (n = 1)]. Bone mineral measurements were performed by dual energy X-ray absorptiometry. Following tibial shaft fractures, a significant decrease in bone mineral density (BMD) was seen at the hip reaching 7% [confidence limits (CL): −10.2%; −3.5%] and 14% (CL: −19.6; −7.8%) after 6 months for the femoral neck and greater trochanter, respectively. In the proximal tibia, bone mineral content (BMC) decreased and was 19% (CL: −27.4%; −9.9%) below the initial value after 6 months. BMD of the lumbar spine remained unchanged. In the cross-sectional study, BMC in the tibia of the injured legs was 43% (CL: −53.2%; −31.9%) below the value in the healthy contralateral legs, and BMD in the femoral neck and greater trochanter, respectively, was 22% (CL: −27.4%; −17.6%) and 24% (CL: −36.3%; −12.1%) below the values in the healthy contralateral legs. With respect to the expected age-related decay of bone mineral after peak bone mass, the loss of bone mineral of the hip and tibia associated with tibial shaft fractures may be considered of clinical importance with increased risk of sustaining a fragility fracture of the lower extremity later in life; and the complicated fractures may even represent a present risk of fracture.