Prevalence, Clinical Implication, and Cause of Spine Hip Discordance in Elderly Patients with Fragility Hip Fracture

초록

Background: Spine-hip discordance (SHD) increases fracture risk. However, its preva- lence and clinical implications have not been investigated in patients with hip fractures. This study determined the prevalence and association of SHD with mortality and inves- tigated the cause of SHD in patients with hip fractures. Methods: This study included patients admitted for fragility hip fractures between 2011 and 2020. All patients under- went dual energy X-ray absorptiometry and anteroposterior and lateral views of the lumbosacral spine during admission. Data on demographics, diagnosis, American Soci- ety of Anesthesiologists score, and mortality were collected. A T-score difference of more than 1.5 between L1-4 and the femur neck was considered discordant, and 3 groups (lumbar low [LL] discordance, no discordance [ND], and femur neck low [FL] discordance) were compared. In the discordance group, lumbar radiographs were reviewed to deter- mine the cause of discordance. Results: Among 1,220 eligible patients, 130 were ex- cluded due to patient refusal or bilateral hip implantation; therefore, this study included 1,090 patients (271 male and 819 female). The prevalence of LL, ND, and FL was 4.4%, 66.4% and 29.2% in men and 3.9%, 76.1%, and 20.0% women. Mortality was not associ- ated with discordance. The most common causes of discordance were physiological in the LL group and pathological in the FL group for both sexes. Conclusions: Patients with hip fractures showed lower rates of ND and higher rates of FL compared to the general population. True discordance should be carefully judged for pathological and artifact reasons. The clinical implications of SHD require further investigation.

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