Chung Hee Chung, Choi Woorim, Kim Chul-Ho, Kim Ji Wan
University of Ulsan College of Medicine, Republic of Korea.
Department of Orthopedic Surgery, Asan Medical Center, Seoul, Republic of Korea.
Bone. 2025 Jan;190:117278. doi: 10.1016/j.bone.2024.117278. Epub 2024 Oct 13.
Sarcopenia is linked to increased fall and hip fracture risk. However, studies often overlook comprehensively controlling for age, sex, bone mineral density (BMD), and body mass index (BMI). Our study aimed to determine if sarcopenia, determined by evaluating the psoas muscle volume, is an independent risk factor for hip fractures. We employed a methodological approach that includes the exact matching technique.
In this cross-sectional comparative study, we compared the data of patients who sustained hip fractures between 2015 and 2021 with those of a control group from a health screening center in a single center. The study included 545 patients with hip fractures and 1292 without fractures. We collected data on demographics, BMD determined using dual-energy X-ray absorptiometry, and abdominal and pelvic computed tomography (APCT) scans for psoas muscle volume analysis.
The analysis after exact matching of 266 pairs revealed that psoas volume/height was the most significant and dominant risk factor among the evaluated indices. Multivariate logistic regression analysis, adjusting for age, sex, BMI, and BMD, identified height or height-adjusted psoas muscle volume as an independent risk factor for hip fractures (p = 0.042 and p = 0.002, respectively). Age, female sex, lower BMI, and lower BMD were associated with an increased risk of hip fractures.
Decreased psoas muscle volume adjusted for patient height independently predicts hip fracture risk. Psoas volume assessment via APCT is a practical tool for identifying at-risk individuals, emphasizing the necessity of including sarcopenia in hip fracture risk assessments.
肌肉减少症与跌倒及髋部骨折风险增加有关。然而，以往研究常常忽视对年龄、性别、骨密度（BMD）和体重指数（BMI）进行全面控制。我们的研究旨在确定通过评估腰大肌体积所确定的肌肉减少症是否为髋部骨折的独立危险因素。我们采用了一种包括精确匹配技术在内的方法。
在这项横断面比较研究中，我们将2015年至2021年期间发生髋部骨折的患者数据与来自单一中心健康筛查中心的对照组患者数据进行了比较。该研究纳入了545例髋部骨折患者和1292例未发生骨折的患者。我们收集了人口统计学数据、使用双能X线吸收法测定的骨密度，以及用于腰大肌体积分析的腹部和盆腔计算机断层扫描（APCT）图像。
对266对数据进行精确匹配后的分析显示，腰大肌体积/身高是评估指标中最显著且占主导地位的危险因素。在对年龄、性别、BMI和BMD进行校正的多因素逻辑回归分析中，身高或身高校正后的腰大肌体积被确定为髋部骨折的独立危险因素（p值分别为0.042和0.002）。年龄、女性、较低的BMI和较低的BMD与髋部骨折风险增加相关。
根据患者身高调整后的腰大肌体积减小独立预测髋部骨折风险。通过APCT评估腰大肌体积是识别高危个体的实用工具，强调了在髋部骨折风险评估中纳入肌肉减少症的必要性。
