Analysis of Combined Indicators for Risk of Osteoporotic Hip Fracture in Elderly Women

Objective To compare the accuracy of combined independent risk factors in assessing the risk of hip fractures in elderly women. Methods Ninety elderly females who sustained hip fractures (including femoral neck fractures and intertrochanteric fractures) and 110 female outpatients without a hip fracture were included in our cross-sectional study from 24 November 2017 to 20 May 2019. The age of subjects in the present study was >= 65 years, with the mean age of 78.73 +/- 7.77 and 78.09 +/- 5.03 years for women with and without elderly hip fractures, respectively. Bone mineral density (BMD), Beta-carboxy terminal telopeptide (beta-CTX), N-terminal/mid region (N-MID), and 25(OH)D levels were analyzed. A novel evaluation model was established to evaluate combined indicators in assessing hip fractures in elderly women. Results Compared with the control group, taller height (155.68 +/- 6.40 vs 150.97 +/- 6.23, P < 0.01), higher levels of beta-CTX (525.91 +/- 307.38 vs 330.94 +/- 289.71, P < 0.01), and lower levels of total hip BMD (0.662 +/- 0.117 vs 0.699 +/- 0.111, P = 0.022), femoral neck BMD (0.598 +/- 0.106 vs 0.637 +/- 0.100, P = 0.009), and 25(OH)D (15.67 +/- 7.23 vs 29.53 +/- 10.57, P < 0.01) were found in the facture group. After adjustment for confounding factors, logistic regression analysis revealed that 25(OH)D (adjusted OR 0.837 [95% CI 0.790-0.886]; P < 0.01), femoral neck BMD (adjusted OR 0.009 [95% CI 0.000-0.969]; P = 0.048) and height (adjusted OR 1.207 [95% CI 1.116-1.306]; P < 0.01) remained risk factors for hip fractures in elderly women. Then a model including independent risk factors was established. A DeLong test showed the area under the receiver operator characteristic (ROC) (Area under the curve [AUC]) of 25(OH)D was significantly greater than that for femoral neck BMD (P < 0.01) and height (P < 0.01). The AUC of model including 25(OH)D and height was significantly greater than that of other combinations (P < 0.01). Conclusion 25(OH)D, femoral neck BMD and height were associated with the occurrence of hip fractures in elderly women even after adjustment for confounding factors, and a model including 25(OH)D and height could provide better associated power than other combinations in the assessment of elderly hip fractures.