Analysis on the bone mineral density characteristics and the risk factors of concurrent frailty in elderly patients with hip fractures

CHEN Zhifang; YU Xiaohong; MA Kangkang

doi:10.3969/j.issn.1674-3806.2025.01.09

Abstract：Objective To analyze the bone mineral density characteristics and the risk factors of concurrent frailty in elderly patients with hip fractures.Methods The clinical data of 267 elderly patients with hip fractures who were admitted to Beijing Jishuitan Hospital,Captial Medical University from September 2021 to November 2021 were retrospectively analyzed,and according to the evaluation results of the 5-item FRAIL scale,the patients were divided into frail group(with concurrent frailty,110 cases)and non-frail group(without concurrent frailty,157 cases).The results of hip joint volumetric bone mineral density(vBMD)measured by quantitative computed tomography(QCT)were compared between the two groups,as well as the clinical data including demographic characteristics,Charlson comorbidity index(CCI)scores,calf circumference,fibrinogen-to-prealbumin ratio(FPR),biochemical markers of bone metabolism and risk of sarcopenia.Multivariate logistic regression was used to analyze the factors influencing concurrent frailty in the elderly patients with hip fractures.Results The frail group was older than the non-frail group,and the levels of FDR beta-isomerized C-terminal telopeptide of type Ⅰ collagen(β-CTX),total procollagen type Ⅰ N-terminal propeptide(tP1NP),as well as the proportion of the patients with nutritional risk,risk of sarcopenia and CCI scores＞2 points in the frail group were higher than those in the non-frail group,and the levels of body mass index(BMI),free triiodothyronine(FT3),calf circumference,trabecula vBMD of the total hip bone(THT vBMD),trabecula vBMD of the femoral neck(FNT vBMD),trabecula vBMD of the intertrochanter(ITT vBMD)and serum 25-(OH)D3 in the frail group were lower than those in the non-frail group,and the differences were statistically significant(P＜0.05).The results of stratified analysis showed that in the female patients,the levels of THT vBMD and FNT vBMD in the frail group were significantly lower than those in the non-frail group(P＜0.05),and in the male patients,only THT vBMD levels in the frail group were significantly lower than those in the non-frail group(P＜0.05).The results of multivariate logistic regression analysis showed that older age,elevated levels of β-CTX and FPR,as well as nutritional risk and CCI scores greater than 2 points were independent risk factors for promoting the occurrence of frailty,while elevated levels of calf circumference,THT vBMD,and 25-(OH)D3 were protective factors for inhibiting the occurrence of frailty(P＜0.05).Conclusion Hip bone mineral density in elderly patients with hip fractures and concurrent frailty is characterized by reduced THT vBMD,FNT vBMD,and ITT vBMD.In addition to the factors of age,nutritional status,calf circumference and comorbidities,biochemical markers of bone metabolism β-CTX and 25-(OH)D3 are also significantly associated with frailty.Clinicians should pay attention to these factors and conduct stratified management as soon as possible to improve the prognosis of the patients.