title: Femoral cortical index: an indicator of poor bone quality in patient with hip fracture.
abstract: BACKGROUND
  Osteoporosis is a common disease in elderly, characterized by poor bone quality as a result of alterations affecting trabecular bone. However, recent studies have described also an important role of alterations of cortical bone in the physiopathology of osteoporosis. Although dual-energy X-ray absorptiometry (DXA) is a valid method to assess bone mineral density, in the presence of comorbidities real bone fragility is unable to be evaluated. The number of hip fractures is rising, especially in people over 85 years old.
  
  
  OBJECTIVE
  The aim is to evaluate an alternative method so that it can indicate fracture risk, independent of bone mineral density (BMD). Femoral cortical index (FCI) assesses cortical bone stock using femur X-ray.
  
  
  METHODS
  A retrospective study has been conducted on 152 patients with hip fragility fractures. FCI has been calculated on fractured femur and on the opposite side. The presence of comorbidities, osteoporosis risk factors, vitamin D levels, and BMD have been analyzed for each patient.
  
  
  RESULTS
  Average values of FCI have been 0.42 for fractured femurs and 0.48 at the opposite side with a statistically significant difference (p = 0.002). Patients with severe hypovitaminosis D had a minor FCI compared to those with moderate deficiency (0.41 vs. 0.46, p < 0.011). 42 patients (27.6%) with osteopenic or normal BMD have presented low values of FCI.
  
  
  CONCLUSIONS
  A significant correlation among low values of FCI, comorbidities, severe hypovitaminosis D. and BMD in patients with hip fractures has been found. FCI could be a useful tool to evaluate bone fragility and to predict fracture risk even in the normal and osteopenic BMD patients.
authors.affiliation: Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Feola
authors.affiliation: Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy. cecilia.rao85@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Rao
authors.affiliation: Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Tempesta
authors.affiliation: Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Gasbarra
authors.affiliation: Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy.
authors.forename: U
authors.initials: U
authors.lastname: Tarantino
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D015897:Comorbidity; D005260:Female; D005269:Femur / Q000473:pathology*; D006305:Health Status Indicators; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D010024:Osteoporosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014807:Vitamin D / Q000097:blood
chemical_list: D014807:Vitamin D
keywords: Bone mineral density; Bone quality; Comorbidity; Cortical thickness; Fragility fracture; Hip fracture