Estimation of Femoral Head Bone Mineral Density in Hip Fractures of the Elderly

  • Bilal Koyuncu Manisa State Hospital
  • Murat Songür Bülent Ecevit University
  • Selçuk Keser Bülent Ecevit University
  • Ercan Şahin Bülent Ecevit University
  • Selda Sarıkaya Bülent Ecevit University
  • Ahmet Bayar Bülent Ecevit University
  • Onur Kaymakçı Muş State Hospital
Keywords: Osteoporosis, BMD, proximal femur fracture, hemiarthroplasty, internal fixation


Objective: It is usually challenging to decide which hip fractures should be fixed and which should be replaced to avoid fixation failure and revision. Therefore, it may be of benefit to evaluate the bone mineral density of the fixation point of the femoral head preoperatively. In this study we tried to investigate the relationship between the bone mineral density (BMD) of the fixation point of femoral head, which is the primary compressive trabeculation area, and other parts of the proximal femur evaluated routinely during Dual-Energy X-ray absorptiometry (DXA) measurements.Methods: Retrieved femoral heads of 29 patients during hemiarthroplasty for hip fracture were evaluated using DXA. These results were correlated with the DXA measurements of proximal femora of uninvolved hips of patients.Results: Mean BMD values of retrieved femoral head primary compressive trabecular region (PC-BMD) values were 0.610 ± 11 (g/cm²). Although there were significant positive correlation of PC-BMD with neck, Ward's and total proximal femoral region as expected, highest correlation coefficient was calculated at femoral neck region. These results did not differ when patients were regrouped according to uninvolved side BMD values as osteoporotic and osteopenic. There were no difference in both sexes in this relationship between values of PC-BMD, neck BMD, Ward’s BMD and total BMD.Conclusion: As expected, a positive relationship was found between PC-BMD values and neck BMD, ward’s BMD and total BMD values with neck BMD revealing the highest correlation. Preoperative bone mineral densitometric evaluation of the uninvolved hip, especially the neck region seems to be helpful to evaluate the densitometric status of femoral head to predict early failure when fixation was attempted. 


Sjostedt A, Zetterberg C, Hansson T, Hult E, Ekstrom L. Bone mineral content and fixation strength of femoral neck fractures. A cadaver study. Acta Orthop Scand. 1994;65:161–5.

Dalen N, Jakobsson B. Factors influencing the incidence of reoperation after femoral neck fractures. Int Orthop. 1985;9:235–7.

Bonnaire FA, Buitrago-Tellez C, Schmal H, Götze B, Weber AT. Correlation of bone density and geometric parameter to mechanical strength of the femoral neck. Injury 2002;33(Suppl 3):47–53.

Bonnaire F, Zenker H, Lill C, Weber AT, Linke B. Treatment strategies for proximal femur fractures in osteoporotic patients. Osteoporosis int. 2005;16:93-102.

Hedström M. Are patients with a nonunion after a femoral neck fracture more osteoporotic than others? BMD measurement before the choice of treatment? Acta Orthop Scand. 2004 Feb;75(1):50-2.

Jenny J, Rapp E, Cordey J. Type of screw does not influence holding power in the femoral head. Acta Orthop Scand. 1999;70:435-8.

Fensky F, Nüchtern JV, Kolb JP, Huber S et al. Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures--a biomechanical cadaver study. Injury. 2013;44:802-7.

Claes L, Becker C, Simnacher M, Hoellen I. Improvement in the primary stability of the dynamic hip screw osteosynthsis in unstable, pertrochanteric femoral femoral fractures of osteoporotic bones by a new glass inomer cement. Unfallchirurg. 1995;98:118–23.

Hamdy R, Kiebzak GM, Seier E, Watts NB. The prevalence of significant left- right differences in hip bone mineral density. Osteoporos Int. 2006;17:1772-80.

Mounach A, Rezqi A, Ghozlani I, Achemlal L, Bezza A, El Maghraoui A. Prevalence and Risk Factors of Discordance between Left-and Right-Hip Bone Mineral Density Using DXA. ISRN Rheumatol. 2012;ID:617535. doi: 10.5402/2012/617535.

Original Research