title: Femoral geometry, bone mineral density, and the risk of hip fracture in premenopausal women: a case control study.
abstract: BACKGROUND
  The purpose of this study was to determine the relationships among hip geometry, bone mineral density, and the risk of hip fracture in premenopausal women.
  
  
  METHODS
  The participants in this case-control study were 16 premenopausal women with minimal-trauma hip fractures (fracture group) and 80 age-and BMI-adjusted controls. Subjects underwent dual-energy X-ray absorptiometry (DXA) to assess BMD at the proximal femur and to obtain DXA-derived hip geometry measurements.
  
  
  RESULTS
  The fracture group had a lower mean femoral neck and total hip BMD than the control group (0.721 ± 0.123 vs. 0.899 ± 0.115, p <0.001 for the femoral neck BMD and 0.724 ± 0.120 vs. 0.923 ± 0.116, p <0.001 for the total hip BMD). In addition, participants in the fracture group had a longer hip axis length (HAL; p = 0.007), narrower neck shaft angle (NSA; p = 0.008), smaller cross sectional area (CSA; p < 0.001) and higher cross sectional moment of inertia (CSMI; p = 0.004) than those in control group. After adjusting for BMD, the fracture group still had a significantly longer mean HAL (p = 0.020) and narrower NSA (p = 0.006) than the control group.
  
  
  CONCLUSIONS
  BMD is an important predictor of hip fracture in premenopausal women. Furthermore, HAL and NSA are BMD-independent predictors of hip fracture in premenopausal women. Hip geometry may be clinically useful for identification of premenopausal women for whom active fracture prevention should be considered.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. roroko0902@gmail.com.
authors.forename: Dong-Hwa
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Kyunggi-do, 463-707, Korea. yeun6486@gmail.com.
authors.forename: Kyong Yeun
authors.initials: KY
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. wanilove23@nate.com.
authors.forename: A Ram
authors.initials: AR
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. jhkxingfu@gmail.com.
authors.forename: Jung Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Kyunggi-do, 463-707, Korea. kyoungmin02@gmail.com.
authors.forename: Kyoung Min
authors.initials: KM
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. csshin@snu.ac.kr.
authors.forename: Chan Soo
authors.initials: CS
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. seongyk@plaza.snu.ac.kr.
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 156-707, Korea. swkimmd@snu.ac.kr.
authors.forename: Sang Wan
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000328:Adult; D015519:Bone Density / Q000502:physiology*; D016022:Case-Control Studies; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging*; D006620:Hip Fractures / Q000000981:diagnostic imaging*; D006801:Humans; D017697:Premenopause / Q000502:physiology*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors
references.citation: J Bone Miner Res. 1994 Jul;9(7):1065-70
references.pmid: 7942153
references.citation: Br J Radiol. 2012 Aug;85(1016):e467-73
references.pmid: 22096224
references.citation: J Womens Health (Larchmt). 2010 May;19(5):869-76
references.pmid: 20350203
references.citation: Lancet. 2002 Jun 1;359(9321):1929-36
references.pmid: 12057569
references.citation: Osteoporos Int. 2000;11(8):714-20
references.pmid: 11095176
references.citation: Osteoporos Int. 2005 Oct;16(10):1299-303
references.pmid: 16082496
references.citation: Curr Osteoporos Rep. 2003 Jun;1(1):25-31
references.pmid: 16036062
references.citation: Osteoporos Int. 2009 Oct;20(10):1767-74
references.pmid: 19238304
references.citation: Osteoporos Int. 2003 Sep;14 Suppl 5:S81-8
references.pmid: 14504711
references.citation: BMJ. 1996 May 18;312(7041):1254-9
references.pmid: 8634613
references.citation: Osteoporos Int. 2013 Oct;24(10):2627-37
references.pmid: 23592044
references.citation: J Bone Miner Res. 1996 Feb;11(2):293-7
references.pmid: 8822354
references.citation: Invest Radiol. 1990 Jan;25(1):6-18
references.pmid: 2298552
references.citation: Endocrinol Metab (Seoul). 2013 Jun;28(2):90-3
references.pmid: 24396660
references.citation: Curr Osteoporos Rep. 2006 Jun;4(2):49-56
references.pmid: 16822403
references.citation: Osteoporos Int. 2002 Jul;13(7):542-50
references.pmid: 12111014
references.citation: J Bone Miner Res. 2001 Aug;16(8):1540-6
references.pmid: 11499877
references.citation: Bone. 2014 Jun;63:1-6
references.pmid: 24565751
references.citation: Br J Radiol. 1999 Aug;72(860):729-33
references.pmid: 10624337
references.citation: Osteoporos Int. 2002 Jan;13(1):48-54
references.pmid: 11883408
references.citation: J Bone Miner Res. 2000 Dec;15(12):2297-304
references.pmid: 11127194
references.citation: J Bone Miner Res. 1993 Oct;8(10):1227-33
references.pmid: 8256660
references.citation: Osteoporos Int. 1995 May;5(3):167-73
references.pmid: 7655177
references.citation: Osteoporos Int. 1998;8(1):75-81
references.pmid: 9692081
references.citation: J Clin Endocrinol Metab. 2015 May;100(5):2063-70
references.pmid: 25751108
references.citation: Osteoporos Int. 1994 Jul;4(4):226-9
references.pmid: 7949753
references.citation: Osteoporos Int. 2006;17(4):593-9
references.pmid: 16447009
references.citation: Osteoporos Int. 2012 Dec;23(12):2735-48
references.pmid: 22684497
references.citation: J Bone Miner Res. 2005 Oct;20(10):1820-7
references.pmid: 16160739
references.citation: J Bone Miner Res. 1993 Oct;8(10):1211-7
references.pmid: 8256658