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Fatty infiltration of hip muscles and trochanteric soft tissue thickness are associated with hip fractures in the elderly

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Abstract

Purpose

Apart from bone conditions, muscle and soft tissue parameters might also influence hip fractures. We aimed to evaluate the association between hip muscle and trochanteric soft tissue parameters and hip fractures.

Methods

We retrospectively reviewed 60 patients with hip fractures and 114 controls without hip fractures. Cases and controls were matched for age, sex, and body mass index using propensity score matching. Muscle cross-sectional area (CSA), mean attenuation, and fatty infiltration rate (FIR) (proportion of intramuscular fat content) were measured on CT images for the gluteus maximus, the gluteus medius/minimus, and the anterior and medial compartments of the upper thigh. Trochanteric soft tissue thickness (TSTT) and femoral neck attenuation were also measured. Univariate and multivariate analyses were conducted to identify potential risk factors of hip fractures.

Results

Patients with hip fractures had significantly lower femoral neck attenuation, TSTT, and CSA of the gluteus maximus and anterior compartment than controls. FIR of all hip muscle groups were significantly higher in hip fracture patients than controls. Multivariate analysis revealed that every 1% increase in FIR of medial compartment independently increased the odds of hip fractures by 23.7% (OR = 1.237, 95% CI = 1.093–1.401) and every 1 cm longer TSTT independently decreased the odds by 32.8% (OR = 0.672, 95% CI = 0.477–0.946).

Conclusion

Fatty infiltration of hip muscles can better discriminate hip fractures than muscle area. Increased TSTT is independently associated with low fracture risk.

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Author information

Authors and Affiliations

  1. Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS), Beijing, China

    Junsheng Leng, Xiao Chang, Qiushi Bai, Jia Zhang, Peng Gao, Yu Fan, Xiongfei Zou, Hengyan Zhang & Baozhong Zhang

  2. Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS), Beijing, China

    Yun Wang & Xingyu Liu

Authors
  1. Junsheng Leng
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  2. Xiao Chang
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  3. Qiushi Bai
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  4. Yun Wang
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  5. Xingyu Liu
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  6. Jia Zhang
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  7. Peng Gao
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  8. Yu Fan
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  10. Hengyan Zhang
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  11. Baozhong Zhang
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Contributions

All authors contributed to the study conception and design. Data collection was performed by Yun Wang, Xingyu Liu, Jia Zhang, Peng Gao, Yu Fan, Xiongfei Zou, and Hengyan Zhang. Measurements were performed by Junsheng Leng. Analysis was performed by Xiao Chang, Qiushi Bai, and Baozhong Zhang. The first draft of the manuscript was written by Junsheng Leng and Baozhong Zhang. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Baozhong Zhang.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Peking Union Medical College Hospital (No. S-K1918).

Consent to participate

This is a retrospective study, and the identity of the patients cannot be revealed. Consent to participate was waived according to the ethics committee of our institution.

Consent for publication

In this study, CT images of one patient from the study cohort are used to illustrate the measurement technique. These images are anonymized, and there is no concern that the identity of this patient would be revealed. There is no need in this case to acquire informed consent from this specific patient according to instructions of this journal.

Competing interests

The authors declare no competing interests.

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Leng, J., Chang, X., Bai, Q. et al. Fatty infiltration of hip muscles and trochanteric soft tissue thickness are associated with hip fractures in the elderly. International Orthopaedics (SICOT) 46, 2963–2969 (2022). https://doi.org/10.1007/s00264-022-05563-2

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