Abstract

Objective: To compare hip fracture incidence in post-menopausal women who were differently stratified for the fracture risk according to bone mineral density and proximal femur geometry.Methods: In a 5-year follow-up study, hip fracture incidence in 729 post-menopausal women (45 of whom suffered from incident hip fracture) was assessed and compared. Forward logistic regression was used to select independent predictors of hip fracture risk, including age, age at menopause, height, weight, femoral neck bone mineral density (FNBMD), neck-shaft angle (NSA), hip axis length, femoral neck diameter and femoral shaft diameter as covariates. Fracture incidence was then calculated for the categories of young/old age, high/low FNBMD and wide/narrow NSA, which were obtained by dichotomising each hip fracture independent predictor at the value best separating women with and without a hip fracture.Results: The hip fracture incidence of the whole cohort was significantly higher in women having wide NSA (8.52%) than in those with narrow NSA (3.51%). The combination of wide NSA and low FNBMD had the highest hip fracture incidence in the whole cohort (17.61%) and each age category. The combinations of narrow/wide NSA with low/high FNBMD respectively gave significantly higher fracture incidence in older than in younger women, whereas women with combined wide NSA low FNBMD had no significantly different fracture incidence in young (14.60%) or old age (21.62%).Conclusion: Our study showed that NSA is effective at predicting the hip fracture risk and that the detection in early post-menopause of wide NSA together with low FNBMD should identify women at high probability of incident hip fracture.