Can fracture of the femoral neck be predicted?

Hip radiograms made 15 to 25 years previously in 39 women were examined. These women were between 58 and 62 years old when the first radiogram was made, and all sustained cervical or trochanteric fracture of the upper end of the femur on an average of 14 years later. The trabecular pattern of the upper end of the femur was classifed according to Singh, and the medial cortex of the femoral neck was measured and expressed as a fraction of the total width (femoral neck index). For comparison, the same information was collected from a control sample of films taken during the same period in women who did not sustain subsequent hip fracture. The cortex was thinner in women who later had hip fracture than in control women. Women with coxarthrosis had the highest cortical ratio. The trabecular pattern in women who later had hip fracture shifted in the direction of osteoporosis in comparison with the controls. It was not possible to predict from either measurement which hip would fracture or when fracture would occur. This study demonstrates that by using only simple measurements on hip radiograms, it might be possible to include in a sample of women selected for a therapeutic trial those who are likely to sustain hip fracture.