title: Hip structural geometry and incidence of hip fracture in postmenopausal women: what does it add to conventional bone mineral density?
abstract: CONCLUSIONS
  Hip geometry measurements of outer diameter and buckling ratio at the intertrochanter and shaft of the hip dual energy X-ray absorptiometry (DXA) scan predicted incident hip fracture in postmenopausal women. These associations, independent of age, body size, clinical risk factors, and conventional areal bone mineral density, suggest hip geometry plays a role in fracture etiology and may aid in improving identification of older women at high fracture risk.
  
  
  BACKGROUND
  This study examined whether hip geometry parameters predicted hip fracture independent of body size, clinical risk factors, and conventional femoral neck bone mineral density (aBMD) and whether summary factors could be identified to predict hip fracture.
  
  
  METHODS
  We studied 10,290 postmenopausal women from the Women's Health Initiative. Eight thousand eight hundred forty-three remained fracture free during follow-up to 11 years of follow-up, while 147 fractured their hip, and 1,300 had other clinical fractures. Hip structural analysis software measured bone cross-sectional area, outer diameter, section modulus, average cortical thickness, and buckling ratio on archived DXA scans in three hip regions: narrow neck, intertrochanter, and shaft. Hazard ratios were estimated using Cox proportional hazards models for individual parameters and for composite factors extracted from principal components analysis from all 15 parameters.
  
  
  RESULTS
  After adjustment for age, body size, clinical risk factors, and aBMD, intertrochanter and shaft outer diameter measurements remained independent predictors of hip fracture with hazard ratios for a one standard deviation increase of 1.61 (95% confidence interval (CI), 1.25-2.08) for the intertrochanter and 1.36 (95% CI, 1.06-1.76) for the shaft. Average buckling ratios also independently predicted incident hip fracture with hazard ratios of 1.43 (95% CI, 1.10-1.87) at the intertrochanter and 1.24 (95% CI, 1.00-1.55) at the shaft. Although two composite factors were extracted from principal components analysis, neither was superior to these individual measurements at predicting incident hip fracture.
  
  
  CONCLUSIONS
  Two hip geometry parameters, intertrochanter outer diameter and buckling ratio, predict incident hip fracture after accounting for clinical risk factors and aBMD.
authors.affiliation: WHI Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. alacroix@whi.org
authors.forename: A Z
authors.initials: AZ
authors.lastname: LaCroix
authors.forename: T J
authors.initials: TJ
authors.lastname: Beck
authors.forename: J A
authors.initials: JA
authors.lastname: Cauley
authors.forename: C E
authors.initials: CE
authors.lastname: Lewis
authors.forename: T
authors.initials: T
authors.lastname: Bassford
authors.forename: R
authors.initials: R
authors.lastname: Jackson
authors.forename: G
authors.initials: G
authors.lastname: Wu
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density / Q000502:physiology*; D004812:Epidemiologic Methods; D005260:Female; D005269:Femur / Q000473:pathology / Q000503:physiopathology; D005272:Femur Neck / Q000503:physiopathology; D006620:Hip Fractures / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D006621:Hip Joint / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D014481:United States / Q000453:epidemiology