Hip muscle size and density are associated with trochanteric fractures of elderly women

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Methods A total of 554 older women patients were enrolled, including 314 FNF (77.02 ± 7.15 years) and 240 TRF (79.70 ± 6.91 years) for the comparisons. The area and density of the gluteus medius and minimus muscle (G.Med/MinM) and the gluteus maximus muscle (G.MaxM) were measured by CT. Total hip (TH) areal bone mineral density (aBMD) and femoral neck aBMD (FNaBMD) were measured by quantitative CT. A cutoff of 80 years was used to stratify the cohort and to further explore the age-specific relationship. Results For the total subjects, all these muscle parameters were higher in the FNF group than in the TRF group (p < 0.001). The muscle parameters except for the G.Med/MinM density were significantly correlated with hip fracture typing after adjustment for age, BMI, and THaBMD. In the age ≧ 80 group, no statistically significant correlation was found between all hip muscle parameters and fracture types. In contrast, in the age < 80 group, interestingly, after adjustment of age, BMI, and THaBMD, the associations between G.MaxM density, G.MaxM area, G.Med/MinM density, and G.Med/MinM area and fracture type were all statistically significant. Conclusions Our results indicate that in older women, especially under 80 years of age, gluteus muscle parameters are related to trochanteric fractures. Osteoporosis Muscle density Muscle area Femoral neck fracture Trochanteric fractures Figures Figure 1 Figure 2 Figure 3 1. Introduction Hip fracture in elderly adults is one of the most severe consequences of osteoporosis, with high morbidity, mortality, and disability rates[ 1 – 3 ]. Hip fracture consists of two main types, femoral neck fracture (FNF) and trochanteric fracture (TRF), which require different treatments and yield different clinical outcomes[ 4 ]. For example, the FNF was associated with a higher incidence of femoral head necrosis and nonunion than the TRF, while the TRF may bring higher mortality risks[ 5 , 6 ]. Therefore, it is critical to explore the potential differences between these two different fracture types. Previous reports identified some factors, i.e., bone structures and spatial distributions, and bone mineral density (BMD) at the femur, to be associated with fracture types[ 7 – 9 ]. However, evidence is still insufficient to draw a robust conclusion regarding the disparities between the two types. Along with the aging process, the age-related loss of muscle compositions and functions directly leads to a dramatic decrease in older adults' ability to balance and, thus, an increased risk of falls. However, to the best of our knowledge, only two studies explored differences in muscle parameters between the two types of hip fragility fractures, but both of these studies did not measure hip bone mineral density, so BMD was not corrected for the comparison, while BMD reduction has been identified in many studies as an important cause of hip fractures[ 10 , 11 ]. Thus, further exploring the association between muscle biomarkers and hip fracture types becomes warranted. In this cross-sectional study, by using a cohort of older hip fracture women with hip CT scans immediately after injury, we aimed to investigate the differences in hip muscle area and density between older patients with femoral neck and trochanteric fractures. We hypothesized that gluteal muscle density and area based on CT measurements might be involved in classifying hip fractures in the elderly. 2. Materials and methods 2.1. Study design and participants From January 2012 to December 2019, 1134 consecutive elderly patients (over 65 years old) with diagnosed hip fractures were recruited for this study (Fig. 1 ). In this institution, CT scans are routinely performed for subjects with suspected or confirmed hip fractures in the Emergency Department. According to the CT image, the fractures were categorized into FNF or TRF by an experienced musculoskeletal radiologist. A one-page questionnaire inquiring about demographic data (e.g., age, gender, height, and weight), details of the fall (when, where, and how), fracture history, and medical history was completed by the patients or their relatives after the CT examination. The inclusion and exclusion criteria for hip fracture patients were similar to those described by Wang et al. [ 12 ]. In short, the inclusion criteria were women, hip fractures caused by low-energy injuries, and the patient's hip CT scan was performed within 48 hours. Patients with a history of hip fractures or other reasons that prevented them from standing or walking were excluded. This cross-sectional study was approved by the Institutional Review Board of XXX Hospital and was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from each patient. 2.2. Computed tomography acquisition and quantitative CT (QCT) analysis The Toshiba Aquilion spiral CT scanner (Toshiba Medical Systems Division, Tokyo, Japan) was used to perform CT scans of all study participants. The subject was scanned in a supine position, with a solid calibration body model (Mindways Software Inc., Austin, TX, USA) located just below the hips. Scans range from the top of the acetabular to 3 cm or longer below the lesser trochanter to cover the proximal femur. Scan parameters were 120 kVp, 125 mAs, 50 cm field of view, 512 × 512 matrix, 1 mm reconstructed slice thickness, and a standard reconstruction kernel with filtered back-projection. After the CT scan, the corresponding image was automatically uploaded to the Mindways QCT workstation. CT X-ray absorptiometry technique (CTXA v 4.2.3, Mindways Inc., Austin, TX) is a QCTPro scan analysis module for the hip that generates a 2D image from 3D CT images of the proximal femur. The measurement procedure was described in detail previously[ 13 , 14 ]. In brief, it divides it into three regions of interest (ROIs), the femoral neck (FN), trochanter (TR), and intertrochanter (IT), that are equivalent to the standard ROIs widely used to interpret DXA hip scans. Thus, it is possible to calculate DXA-equivalent areal bone mineral density (aBMD, g/cm 2 ) results for each ROI as well as the combination of all three to give a measurement equivalent to the total hip (TH) ROI. The aBMD of the femoral neck (FN) and total hip (TH) were calculated from the hip CT scans using the CTXA. The hip BMD on the healthy side was measured for all the patients. 2.3. Muscle Cross-sectional area and density assessments OsiriX software (Lite Version 12.0.2, Pixmeo, Geneva, Switzerland) was used for analysis. The muscle measurement procedure and precision have been reported previously[ 15 ].Two investigators who had received training from an expert radiologist in CT muscle imaging before the analysis performed all muscle measurements, and then the corresponding averages were yielded. Figure 2 showed that cross-sectional area and density were measured of the gluteus maximus (G.MaxM) at the level of the greater trochanter and the gluteus medius and minimus muscle (G.Med/MinM) at the level of the third sacral (S3). 2.4. Statistical analysis Data are presented as means and standard deviations for parametric data, while categorical variables are described using frequencies and numerical distributions. The Chi-squared test was used to assess the differences between the two groups for categorical variables and the Student's t-test for continuous variables. We used a cutoff of 80 to stratify the age and further explore the age-specific relationship between muscle parameters and fracture type. Logistic regression models were used with and without adjustments for age, BMI, and THaBMD. In addition, we applied generalized additive models to identify further the dose-response relationship between the densities and areas of the muscle and probabilities of TRF with and without adjustment for covariates mentioned above. All the analyses were performed with the statistical software package R 4.1.1 ( http://www.R-project.org , The R Foundation). A two-tailed test was performed, and p < 0.05 was considered statistically significant. 3. Results 3.1. Characteristics of subjects Figure 1 illustrates the recruitment of study participants. 580 cases of the 1134 low trauma hip fracture patients were excluded. It is worth mentioning that 215 subjects imaged more than 48 hours after hip fracture were excluded due to prolonged immobilization. A total of 554 hip fracture subjects were eligible for further analysis, including 314 FNF cases and 240 TRF cases. Table 1 shows the distribution of relevant demographic data for these subjects. The FNF group was significantly younger and taller and had higher gluteus muscle area and density and higher aBMD in TH and FN regions. We then stratified the participants into two subgroups using a cutoff of 80 in age (Table 1 ). Table 1 Characteristics of subjects who sustained femoral neck or trochanteric fractures grouped by age Total (n = 554) Age < 80 Age ≥ 80 FN (n = 314) TR (n = 240) p FN (n = 201) TR (n = 110) p FN (n = 113) TR (n = 130) p age, year 77.02 ± 7.15 79.70 ± 6.91 < 0.001 72.69 ± 4.48 73.60 ± 4.07 0.077 84.73 ± 3.69 84.86 ± 4.01 0.797 height, cm 159.15 ± 5.76 157.09 ± 5.84 < 0.001 159.92 ± 5.90 158.69 ± 5.47 0.074 157.78 ± 5.27 155.73 ± 5.83 0.005 weight, kg 58.04 ± 10.53 57.97 ± 11.25 0.944 59.65 ± 10.17 61.04 ± 10.48 0.256 55.16 ± 10.60 55.38 ± 11.27 0.880 BMI, kg/m 2 22.84 ± 3.51 23.43 ± 4.09 0.066 23.26 ± 3.33 24.21 ± 3.83 0.024 22.08 ± 3.69 22.78 ± 4.21 0.175 THaBMD, g/cm 2 0.57 ± 0.11 0.52 ± 0.11 < 0.001 0.59 ± 0.11 0.57 ± 0.10 0.036 0.54 ± 0.10 0.49 ± 0.10 < 0.001 FNaBMD, g/cm 2 0.50 ± 0.10 0.47 ± 0.10 < 0.001 0.51 ± 0.10 0.49 ± 0.09 0.092 0.47 ± 0.09 0.45 ± 0.09 0.076 G.Med/MinM area, cm 2 29.92 ± 7.17 27.24 ± 6.61 < 0.001 31.34 ± 6.94 28.83 ± 6.99 0.003 27.40 ± 6.88 25.88 ± 5.98 0.067 G.Med/MinM density, HU 33.40 ± 6.72 31.04 ± 6.81 < 0.001 34.92 ± 6.50 31.97 ± 6.72 < 0.001 30.68 ± 6.26 30.24 ± 6.82 0.603 G.MaxM area, cm 2 31.01 ± 6.81 28.40 ± 6.44 < 0.001 32.57 ± 6.66 30.48 ± 6.86 0.009 28.24 ± 6.21 26.63 ± 5.50 0.034 G.MaxM density, HU 25.71 ± 7.41 22.52 ± 7.34 < 0.001 27.11 ± 7.36 23.62 ± 7.57 < 0.001 23.24 ± 6.86 21.58 ± 7.04 0.064 All the quantitative variables were expressed as mean ± SD (standard deviation). TH: total hip; FN: femoral neck fracture; TR: trochanteric fracture;aBMD: areal bone mineral density; BMI: body mass index; G.Med/MinM: gluteus medius and minimus muscle; G.MaxM: gluteus maximus. Table.2 Odds ratios for discrimination of hip fracture type per 1 SD of variables crude. OR (95CI) adj.OR (95CI)* adj.OR (95CI) # Total (n=554) G.Med/MinM area 0.94 (0.92~0.97) 0.95 (0.93~0.98) 0.97 (0.94~0.99) G.Med/MinM density 0.95 (0.93~0.97) 0.96 (0.94~0.99) 0.98 (0.95~1.01) G.MaxM area 0.94 (0.92~0.97) 0.94 (0.91~0.97) 0.95 (0.92~0.99) G.MaxM density 0.94 (0.92~0.97) 0.96 (0.93~0.98) 0.97 (0.95~1.00) Age <80 G.Med/MinM area 0.95 (0.91~0.98) 0.95 (0.91~0.98) 0.95 (0.92~0.99) G.Med/MinM density 0.93 (0.90~0.97) 0.94 (0.90~0.97) 0.95 (0.91~0.98) G.MaxM area 0.95 (0.92~0.99) 0.94 (0.90~0.98) 0.94 (0.91~0.98) G.MaxM density 0.94 (0.91~0.97) 0.95 (0.91~0.98) 0.95 (0.92~0.99) Age ≥80 G.Med/MinM area 0.96 (0.93~1.00) 0.96 (0.92~1.00) 0.99 (0.94~1.04) G.Med/MinM density 0.99 (0.95~1.03) 0.99 (0.95~1.03) 1.02 (0.98~1.07) G.MaxM area 0.95 (0.91~1.00) 0.94 (0.89~0.98) 0.97 (0.92~1.02) G.MaxM density 0.97 (0.93~1.00) 0.97 (0.93~1.01) 1.00 (0.96~1.04) SD, standard deviation; OR, odds ratio; CI, confidence interval; G.Med/MinM: gluteus medius and minimus muscle; G.MaxM: gluteus maximus. * adjustment for age and body mass index. # adjustment for age, body mass index, and total hip areal bone mineral density. 3.2. Associations of muscle size and density variables with trochanteric fractures All measurements of the area and density except for G.Med/MinM density were found to be significantly associated with TRF after adjusting for age and BMI (Table 2). What’s more, these associations were still significant after further adjusting for THaBMD (Table 2, Fig. 3 ). G.Med/MinM density (adj.OR 0.98,0.95 ~ 1,01) was on the border associated with TRF after adjustments for age, BMI, and THaBMD. 3.3. Relationship between muscle variables and age Furthermore, we found a much stronger relationship between gluteus and TRF in the younger group (age 80) (Table 2). After adjustment, all the performances of gluteus muscles were still statistically significant in the younger group (age < 80) (G.Med/MinM area, 0.96 (0.92 ~ 0.99); G.Med/MinM density, 0.95 (0.91 ~ 0.98); G.MaxM area, 0.95 (0.91 ~ 0.99); G.MaxM density, 0.95(0.92 ~ 0.98)) ( P < 0.01, Table 2, Fig. 3 ). 4. Discussion In this cross-sectional study, we exploited CT images to obtain data on the density and area of hip muscles in acute low-energy hip fracture women, and our study showed that in older women, especially under 80 years of age, the area and density of the gluteus muscles were significantly associated with trochanteric fractures. After further adjustment for THaBMD, the associations were reduced but remained significant for most muscle parameters. Regarding the differences between the two fracture subtypes (FNF and TRF) of hip fracture, a review by Mautalen et al. reported that women with TRF are older, thinner, and shorter, and the two fracture subtypes may also have different ethnic and geographic patterns[ 16 ]. In our study, the TRF groups were consistently older and shorter. In a case-control study, Yu et al. applied statistical multiparameter mapping to investigate spatial differences in proximal femur density and cortical bone characteristics between the two main types of hip fractures, and the results show that there were different spatial distributions of trabecular volumetric BMD between the two types of hip fractures[ 7 ]. However, few studies have explored whether there are differences in muscle parameters between the two types of hip fractures. Muscle density measured by CT as mean attenuation of skeletal muscle in Hounsfield units (HU) has already been widely used in research studies[ 17 – 20 ] to assess muscle quality, because a low tissue HU (low muscle density) may be a marker of lipid or fluid infiltration in skeletal muscles that can be accompanied by functional changes[ 21 ]. Wang L et al. showed that muscle density performs better than aBMD from hip CTXA and muscle size in discrimination of hip fracture[ 12 ]. In 2008, Lang et al. reported that subjects with hip fractures showed trends towards lower hip muscle CSA and lower lean tissue muscle HU (reflecting greater fatty infiltration of the musculature) than controls[ 22 ]. Then in 2010, Lang et al. reported that decreased thigh muscle HU is associated with an increased risk of hip fracture[ 23 ]. All these studies indicated that muscle density plays a vital role in assessing physical function or fracture risk[ 24 ]. We hypothesized that gluteal muscle density and area may be involved in classifying hip fractures in the elderly. The gluteus maximus is located in the shallow layer of the gluteal muscle, its main movement is the hip extension and external rotation, and its upper area also acts as a hip abductor muscle[ 25 , 26 ]. The anterior upper part of the gluteal median muscle is located under the skin, and the posterior lower part is located on the deep side of the gluteus maximus, and its primary role is to abduct the hip joint (the anterior muscle bundle rotates the hip joint, and the posterior muscle bundle rotates the hip joint out)[ 26 , 27 ]. The gluteus minimus muscles are located on the deep side of the gluteus medius muscle and act the same way as the gluteal median muscle, so this study analyzed these two muscles as a whole. Erinç et al. reported that the gluteal median muscle and gluteus minimus muscle areas in the FNF group are higher than those in the TRF group, but there was no significant difference in the atrophy scores between subjects with TRF versus FNF[ 10 ]. Our study showed that the TRF group had a smaller area of G.Med/MinM than the FNF group in women older than 65 years, which is consistent with the above study's findings. Moreover, the difference was still statistically significant after adjusting for age, BMI, and THaBMD. Furthermore, G.MaxM density and size were also associated with the risk of TRF in women older than 65 years independently of hip aBMD. Similarly, Wang L et al. [ 15 ] showed that the G.MaxM density was significantly associated with physical performance in older women, with or without adjustment for age, height, and weight. This study revealed the important role of the G.MaxM muscle. Interestingly, after we grouped patients by age 80, the difference in muscle parameters between the two fracture types in the over 80 years old group was no longer statistically significant after adjustment of covariates. However, in the 65–80 age group, muscle parameters, especially G.MaxM, were more strongly related to TRF. The explanations for the age effect on muscle parameters with the risk of TRF were unclear. Hip fracture women aged over 80 years seem to be especially frail with low bone mineral density, low cortical thickness, and low muscle quality, thus, we speculated that the incidence of hip fracture type might be a random event. To our knowledge, this is the first study to use a cutoff of 80 to stratify the age and further explore the age-specific relationship between G.MaxM and G.Med/MinM area and density with hip fracture type. Secondly, the subjects imaged more than 48 hours after hip fracture were excluded from our study, making our bone and muscle measurements more reliable. Moreover, several factors for binary logistic regression were calibrated in this study, including BMD, an essential factor that had been overlooked in previous relevant studies. This study has two major limitations. Firstly, this study was cross-sectional-designed, and subsequent longitudinal cohort studies are warranted further to investigate the relationship between gluteal muscles and fracture types. Secondly, in the measurement, we chose to measure the healthy side to replace the data on the fracture side, which may be biased. However, we should take into account that fracture, bleeding, edema, etc., on the fracture side may affect the accuracy of muscle parameter measurements. Meanwhile, Cheng et al.[ 28 ] reflected the excellent symmetry of the hip joint on both sides and maybe it can be further improved if there is better technology in the future. 5. Conclusions In conclusion, we found that in older women especially under 80, gluteus muscle parameters are related to trochanteric fractures. It is well known that age-related loss of muscle mass increases the risk of hip fractures. Therefore, maintaining muscle mass and function, as well as reducing fat infiltration in the muscles, may help prevent trochanteric fractures in older women. Abbreviations FNF femoral neck fractures TRF trochanteric fractures G.Med/MinM gluteus medius and minimus muscle G.MaxM gluteus maximus muscle THaBMD total hip areal bone mineral density FNaBMD femoral neck areal bone mineral density BLR binary logistic regression BMD bone mineral density BMI body mass index QCT quantitative computed tomography CTXA CT X-ray absorptiometry technique HU Hounsfield units Declarations Acknowledgements Not applicable Author Contributions Pengju Huang: Methodology, Writing - Original Draft, Writing- Reviewing; Yufeng Ge: Methodology, Writing- Reviewing and Editing; Aihong Yu: Writing- Reviewing and Editing, Validation; Yandong Liu: Writing- Reviewing and Editing, Investigation, Validation; Jian Geng : Writing- Reviewing and Editing, Validation; Wei Zhang: Investigation, Validation; Wei Liang: Investigation, Validation; Xinbao Wu: Conceptualization, Methodology, Writing- Reviewing and Editing; Ling Wang: Conceptualization, Methodology, Writing- Reviewing and Editing, Supervision; Xiaoguang Cheng: Conceptualization, Methodology, Writing- Reviewing and Editing. All authors reviewed the manuscript and approved the final version. Funding This work is supported in part by the National Key Research and Development Program of China (No. 2020YFC2004902), National Key R&D Program of China (2021YFC2501700), National Natural Science Foundation of China (grant no. 81971617), Beijing Hospitals Authority Youth Programme (code: 20200402), and Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (code: ZYLX202107). Availability of data The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Beijing Jishuitan Hospital (No.201512-02) . Informed consent was obtained from all subjects involved in the study. Consent for publication Not applicable. 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Nakagawa TH, Muniz TB, Baldon Rde M, Dias Maciel C, de Menezes Reiff RB, Serrao FV: The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study . Clin Rehabil 2008, 22 (12):1051-1060. Cheng X, Jing L, Liu X, Wang Y, Li J, Qu h, Genant H, Lang T: The study of bone mineral density and structure in proximal femur by quantitative CT in elderly Chinese women . Chin J Radiol 2009(2):126-130. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFigure1.tif Supplementary Fig. 1. The relationship of the area of Gluteus muscles with the risk of trochanteric fractures SupplementaryFigure2.tif Supplementary Fig. 2. The relationship of the density of Gluteus muscles with the risk of trochanteric fractures Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3600726","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":251634864,"identity":"05c365da-c613-4bef-98ac-36f9a8b650ca","order_by":0,"name":"Pengju Huang","email":"","orcid":"","institution":"Beijing Anding Hospital, Capital Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Pengju","middleName":"","lastName":"Huang","suffix":""},{"id":251634865,"identity":"9d813c39-507f-4b32-9889-158f2ee7155f","order_by":1,"name":"Yufeng Ge","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yufeng","middleName":"","lastName":"Ge","suffix":""},{"id":251634866,"identity":"a131dd1a-a99d-4db3-9add-7960063b4676","order_by":2,"name":"Aihong Yu","email":"","orcid":"","institution":"Beijing Anding Hospital, Capital Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Aihong","middleName":"","lastName":"Yu","suffix":""},{"id":251634867,"identity":"b9cf0f35-edf1-49fd-91f4-daa2c4e2a510","order_by":3,"name":"Yandong Liu","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yandong","middleName":"","lastName":"Liu","suffix":""},{"id":251634868,"identity":"bf4bb43a-801a-40c2-b2c9-4c00486642de","order_by":4,"name":"Jian Geng","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Geng","suffix":""},{"id":251634869,"identity":"8da54390-bb76-418d-8a73-eb396d1c7175","order_by":5,"name":"Wei Zhang","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhang","suffix":""},{"id":251634870,"identity":"fc591b72-0c74-4fcf-832f-6fbb2682179c","order_by":6,"name":"Wei Liang","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Liang","suffix":""},{"id":251634871,"identity":"6ef9fda2-41cf-4e33-bf6c-2f653d76252d","order_by":7,"name":"Xinbao Wu","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xinbao","middleName":"","lastName":"Wu","suffix":""},{"id":251634872,"identity":"7070adba-2f53-43f0-93b7-d684427f7d76","order_by":8,"name":"Ling Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYDCCAxBKhl+CIQHEYGwgQgtYEY/kDJK1GNyA8Alr4Tve/PzBxz2HeYxvNzzdzMNgI7vhAPOzB/i0SJ45Ztg449lhHrM7B9Ju8zCkGW84wGZugE+LwY0cxmaeA7d5zG4kgLQcTtxwgIdNgigtxjPAWv6ToMVAAqzlAGEtIL/MnHHgP48E0C835xgkG888zGaGVwswxB58+HAgTY5/dk/ajTcVdrJ9x5uf4dWCBHgSgO4E0sxEqgcC9gPEqx0Fo2AUjIIRBQCColF8mUQNdgAAAABJRU5ErkJggg==","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ling","middleName":"","lastName":"Wang","suffix":""},{"id":251634873,"identity":"5b3d475c-9262-4e76-bcad-78028bfd9be5","order_by":9,"name":"Xiaoguang Cheng","email":"","orcid":"","institution":"Beijing Jishuitan Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaoguang","middleName":"","lastName":"Cheng","suffix":""}],"badges":[],"createdAt":"2023-11-12 15:59:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3600726/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3600726/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":47000786,"identity":"272bbe74-931c-4230-84d3-a2154fe58c8c","added_by":"auto","created_at":"2023-11-24 00:01:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":560893,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSchematic flow diagram illustrating the stepwise exclusion of subjects with hip injuries.\u003c/strong\u003e FNF, femoral neck fractures; TRF, trochanteric fractures.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3600726/v1/acc0c2bf89fdb059dbb65f96.png"},{"id":47000788,"identity":"b117ec62-2abb-424e-bc07-5265324b84c0","added_by":"auto","created_at":"2023-11-24 00:01:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":912463,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of cross-sectional area and mean CT values of the gluteus maximus at the level of the greater trochanter of the femur(2a); Measurement of the gluteus medius and minimus muscle at the 3rd sacral (S3) level(2b); Muscle region is represented by the area highlighted in red.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3600726/v1/e044e416d5de69af4b194b21.png"},{"id":47000787,"identity":"1edc20bb-0ac4-496b-aa89-f29b1c90fbbf","added_by":"auto","created_at":"2023-11-24 00:01:47","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":295310,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe relationship of the density and area of Gluteus muscles with the risk of trochanteric fractures. \u003c/strong\u003e(3a-d) *These lines refer to the relationship after adjustment for age and body mass index.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3600726/v1/6c6e52131af4e0af5b4e8cc0.png"},{"id":52867551,"identity":"a4493459-0d32-4c3c-bd09-c2073dfcd2fd","added_by":"auto","created_at":"2024-03-18 06:15:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1557603,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3600726/v1/6406d126-304c-42e4-906b-b9901aa529a6.pdf"},{"id":47000791,"identity":"c550af57-bad2-46ac-bfcc-37df87856d5a","added_by":"auto","created_at":"2023-11-24 00:01:48","extension":"tif","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":10240242,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary Fig. 1.\u003c/strong\u003e \u003cstrong\u003eThe relationship of the area of Gluteus muscles with the risk of trochanteric fractures\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"SupplementaryFigure1.tif","url":"https://assets-eu.researchsquare.com/files/rs-3600726/v1/891610070bdd471fe1fd63e9.tif"},{"id":47000790,"identity":"a3eb56ea-292d-43e4-b0f0-1d834932fea5","added_by":"auto","created_at":"2023-11-24 00:01:48","extension":"tif","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":10240242,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary Fig. 2.\u003c/strong\u003e \u003cstrong\u003eThe relationship of the density of Gluteus muscles with the risk of trochanteric fractures\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"SupplementaryFigure2.tif","url":"https://assets-eu.researchsquare.com/files/rs-3600726/v1/ff0c054f6fcc8e81b53dd641.tif"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hip muscle size and density are associated with trochanteric fractures of elderly women","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHip fracture in elderly adults is one of the most severe consequences of osteoporosis, with high morbidity, mortality, and disability rates[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Hip fracture consists of two main types, femoral neck fracture (FNF) and trochanteric fracture (TRF), which require different treatments and yield different clinical outcomes[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. For example, the FNF was associated with a higher incidence of femoral head necrosis and nonunion than the TRF, while the TRF may bring higher mortality risks[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, it is critical to explore the potential differences between these two different fracture types. Previous reports identified some factors, i.e., bone structures and spatial distributions, and bone mineral density (BMD) at the femur, to be associated with fracture types[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, evidence is still insufficient to draw a robust conclusion regarding the disparities between the two types.\u003c/p\u003e \u003cp\u003eAlong with the aging process, the age-related loss of muscle compositions and functions directly leads to a dramatic decrease in older adults' ability to balance and, thus, an increased risk of falls. However, to the best of our knowledge, only two studies explored differences in muscle parameters between the two types of hip fragility fractures, but both of these studies did not measure hip bone mineral density, so BMD was not corrected for the comparison, while BMD reduction has been identified in many studies as an important cause of hip fractures[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Thus, further exploring the association between muscle biomarkers and hip fracture types becomes warranted.\u003c/p\u003e \u003cp\u003eIn this cross-sectional study, by using a cohort of older hip fracture women with hip CT scans immediately after injury, we aimed to investigate the differences in hip muscle area and density between older patients with femoral neck and trochanteric fractures. We hypothesized that gluteal muscle density and area based on CT measurements might be involved in classifying hip fractures in the elderly.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study design and participants\u003c/h2\u003e \u003cp\u003eFrom January 2012 to December 2019, 1134 consecutive elderly patients (over 65 years old) with diagnosed hip fractures were recruited for this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In this institution, CT scans are routinely performed for subjects with suspected or confirmed hip fractures in the Emergency Department. According to the CT image, the fractures were categorized into FNF or TRF by an experienced musculoskeletal radiologist. A one-page questionnaire inquiring about demographic data (e.g., age, gender, height, and weight), details of the fall (when, where, and how), fracture history, and medical history was completed by the patients or their relatives after the CT examination.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe inclusion and exclusion criteria for hip fracture patients were similar to those described by \u003cem\u003eWang et al.\u003c/em\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In short, the inclusion criteria were women, hip fractures caused by low-energy injuries, and the patient's hip CT scan was performed within 48 hours. Patients with a history of hip fractures or other reasons that prevented them from standing or walking were excluded.\u003c/p\u003e \u003cp\u003e This cross-sectional study was approved by the Institutional Review Board of XXX Hospital and was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from each patient.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Computed tomography acquisition and quantitative CT (QCT) analysis\u003c/h2\u003e \u003cp\u003eThe Toshiba Aquilion spiral CT scanner (Toshiba Medical Systems Division, Tokyo, Japan) was used to perform CT scans of all study participants. The subject was scanned in a supine position, with a solid calibration body model (Mindways Software Inc., Austin, TX, USA) located just below the hips. Scans range from the top of the acetabular to 3 cm or longer below the lesser trochanter to cover the proximal femur. Scan parameters were 120 kVp, 125 mAs, 50 cm field of view, 512 \u0026times; 512 matrix, 1 mm reconstructed slice thickness, and a standard reconstruction kernel with filtered back-projection. After the CT scan, the corresponding image was automatically uploaded to the Mindways QCT workstation.\u003c/p\u003e \u003cp\u003eCT X-ray absorptiometry technique (CTXA v 4.2.3, Mindways Inc., Austin, TX) is a QCTPro scan analysis module for the hip that generates a 2D image from 3D CT images of the proximal femur. The measurement procedure was described in detail previously[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In brief, it divides it into three regions of interest (ROIs), the femoral neck (FN), trochanter (TR), and intertrochanter (IT), that are equivalent to the standard ROIs widely used to interpret DXA hip scans. Thus, it is possible to calculate DXA-equivalent areal bone mineral density (aBMD, g/cm\u003csup\u003e2\u003c/sup\u003e) results for each ROI as well as the combination of all three to give a measurement equivalent to the total hip (TH) ROI. The aBMD of the femoral neck (FN) and total hip (TH) were calculated from the hip CT scans using the CTXA. The hip BMD on the healthy side was measured for all the patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Muscle Cross-sectional area and density assessments\u003c/h2\u003e \u003cp\u003eOsiriX software (Lite Version 12.0.2, Pixmeo, Geneva, Switzerland) was used for analysis. The muscle measurement procedure and precision have been reported previously[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].Two investigators who had received training from an expert radiologist in CT muscle imaging before the analysis performed all muscle measurements, and then the corresponding averages were yielded.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e showed that cross-sectional area and density were measured of the gluteus maximus (G.MaxM) at the level of the greater trochanter and the gluteus medius and minimus muscle (G.Med/MinM) at the level of the third sacral (S3).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Statistical analysis\u003c/h2\u003e \u003cp\u003eData are presented as means and standard deviations for parametric data, while categorical variables are described using frequencies and numerical distributions. The Chi-squared test was used to assess the differences between the two groups for categorical variables and the Student's t-test for continuous variables. We used a cutoff of 80 to stratify the age and further explore the age-specific relationship between muscle parameters and fracture type. Logistic regression models were used with and without adjustments for age, BMI, and THaBMD. In addition, we applied generalized additive models to identify further the dose-response relationship between the densities and areas of the muscle and probabilities of TRF with and without adjustment for covariates mentioned above. All the analyses were performed with the statistical software package R 4.1.1 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.R-project.org\u003c/span\u003e\u003cspan address=\"http://www.R-project.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, The R Foundation). A two-tailed test was performed, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003e3.1. Characteristics of subjects\u003c/h2\u003e\n \u003cp\u003eFigure \u003cspan\u003e1\u003c/span\u003e illustrates the recruitment of study participants. 580 cases of the 1134 low trauma hip fracture patients were excluded. It is worth mentioning that 215 subjects imaged more than 48 hours after hip fracture were excluded due to prolonged immobilization. A total of 554 hip fracture subjects were eligible for further analysis, including 314 FNF cases and 240 TRF cases. Table\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e shows the distribution of relevant demographic data for these subjects. The FNF group was significantly younger and taller and had higher gluteus muscle area and density and higher aBMD in TH and FN regions. We then stratified the participants into two subgroups using a cutoff of 80 in age (Table\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCharacteristics of subjects who sustained femoral neck or trochanteric fractures grouped by age\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"12\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;554)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;80\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;80\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFN (n\u0026thinsp;=\u0026thinsp;314)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTR (n\u0026thinsp;=\u0026thinsp;240)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFN (n\u0026thinsp;=\u0026thinsp;201)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTR (n\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFN (n\u0026thinsp;=\u0026thinsp;113)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTR (n\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eage, year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.02\u0026thinsp;\u0026plusmn;\u0026thinsp;7.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.70\u0026thinsp;\u0026plusmn;\u0026thinsp;6.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.69\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.60\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84.86\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.797\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eheight, cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159.15\u0026thinsp;\u0026plusmn;\u0026thinsp;5.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e157.09\u0026thinsp;\u0026plusmn;\u0026thinsp;5.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e158.69\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e157.78\u0026thinsp;\u0026plusmn;\u0026thinsp;5.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eweight, kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.04\u0026thinsp;\u0026plusmn;\u0026thinsp;10.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.97\u0026thinsp;\u0026plusmn;\u0026thinsp;11.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.65\u0026thinsp;\u0026plusmn;\u0026thinsp;10.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.04\u0026thinsp;\u0026plusmn;\u0026thinsp;10.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.38\u0026thinsp;\u0026plusmn;\u0026thinsp;11.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.880\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.84\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.08\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.78\u0026thinsp;\u0026plusmn;\u0026thinsp;4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTHaBMD, g/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFNaBMD, g/cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG.Med/MinM area, cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.92\u0026thinsp;\u0026plusmn;\u0026thinsp;7.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.24\u0026thinsp;\u0026plusmn;\u0026thinsp;6.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.34\u0026thinsp;\u0026plusmn;\u0026thinsp;6.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.83\u0026thinsp;\u0026plusmn;\u0026thinsp;6.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.40\u0026thinsp;\u0026plusmn;\u0026thinsp;6.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.88\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG.Med/MinM density, HU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.40\u0026thinsp;\u0026plusmn;\u0026thinsp;6.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.04\u0026thinsp;\u0026plusmn;\u0026thinsp;6.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.92\u0026thinsp;\u0026plusmn;\u0026thinsp;6.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.24\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG.MaxM area, cm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.01\u0026thinsp;\u0026plusmn;\u0026thinsp;6.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.40\u0026thinsp;\u0026plusmn;\u0026thinsp;6.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.57\u0026thinsp;\u0026plusmn;\u0026thinsp;6.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.48\u0026thinsp;\u0026plusmn;\u0026thinsp;6.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.24\u0026thinsp;\u0026plusmn;\u0026thinsp;6.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.63\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eG.MaxM density, HU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.71\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.52\u0026thinsp;\u0026plusmn;\u0026thinsp;7.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.11\u0026thinsp;\u0026plusmn;\u0026thinsp;7.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.62\u0026thinsp;\u0026plusmn;\u0026thinsp;7.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.24\u0026thinsp;\u0026plusmn;\u0026thinsp;6.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.58\u0026thinsp;\u0026plusmn;\u0026thinsp;7.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\"\u003eAll the quantitative variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (standard deviation).\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\"\u003eTH: total hip; FN: femoral neck fracture; TR: trochanteric fracture;aBMD: areal bone mineral density; BMI: body mass index; G.Med/MinM: gluteus medius and minimus muscle; G.MaxM: gluteus maximus.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eTable.2 Odds ratios for discrimination of hip fracture type per 1 SD of variables\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\" colspan=\"2\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003ecrude. OR (95CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003eadj.OR (95CI)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003eadj.OR (95CI)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.244897959183673%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n=554)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003eG.Med/MinM area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.92~0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.93~0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e0.97 (0.94~0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.906976744186046%\" valign=\"top\"\u003e\n \u003cp\u003eG.Med/MinM density\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.93~0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\" valign=\"top\"\u003e\n \u003cp\u003e0.96 (0.94~0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.41860465116279%\" valign=\"top\"\u003e\n \u003cp\u003e0.98 (0.95~1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.906976744186046%\" valign=\"top\"\u003e\n \u003cp\u003eG.MaxM area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.92~0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.91~0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.41860465116279%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.92~0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.906976744186046%\" valign=\"top\"\u003e\n \u003cp\u003eG.MaxM density\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.92~0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\" valign=\"top\"\u003e\n \u003cp\u003e0.96 (0.93~0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.41860465116279%\" valign=\"top\"\u003e\n \u003cp\u003e0.97 (0.95~1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.244897959183673%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAge \u0026lt;80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003eG.Med/MinM area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.91~0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.91~0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.92~0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.906976744186046%\" valign=\"top\"\u003e\n \u003cp\u003eG.Med/MinM density\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003e0.93 (0.90~0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.90~0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.41860465116279%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.91~0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.906976744186046%\" valign=\"top\"\u003e\n \u003cp\u003eG.MaxM area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.92~0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.90~0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.41860465116279%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.91~0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.906976744186046%\" valign=\"top\"\u003e\n \u003cp\u003eG.MaxM density\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.91~0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.91~0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.41860465116279%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.92~0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.244897959183673%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAge \u0026ge;80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003eG.Med/MinM area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e0.96 (0.93~1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e0.96 (0.92~1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e0.99 (0.94~1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.906976744186046%\" valign=\"top\"\u003e\n \u003cp\u003eG.Med/MinM density\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003e0.99 (0.95~1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\" valign=\"top\"\u003e\n \u003cp\u003e0.99 (0.95~1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.41860465116279%\" valign=\"top\"\u003e\n \u003cp\u003e1.02 (0.98~1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.906976744186046%\" valign=\"top\"\u003e\n \u003cp\u003eG.MaxM area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.91~1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.89~0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.41860465116279%\" valign=\"top\"\u003e\n \u003cp\u003e0.97 (0.92~1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.906976744186046%\" valign=\"top\"\u003e\n \u003cp\u003eG.MaxM density\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.74418604651163%\" valign=\"top\"\u003e\n \u003cp\u003e0.97 (0.93~1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.930232558139537%\" valign=\"top\"\u003e\n \u003cp\u003e0.97 (0.93~1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.41860465116279%\" valign=\"top\"\u003e\n \u003cp\u003e1.00 (0.96~1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;SD, standard deviation; OR, odds ratio; CI, confidence interval; G.Med/MinM: gluteus medius and minimus muscle; G.MaxM: gluteus maximus.\u003c/p\u003e\n \u003cp\u003e* adjustment for age and body mass index.\u003c/p\u003e\n \u003cp\u003e# adjustment for age, body mass index, and total hip areal bone mineral density.\u003c/p\u003e\u0026nbsp;\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\"\u003e\n \u003ch2\u003e3.2. Associations of muscle size and density variables with trochanteric fractures\u003c/h2\u003e\n \u003cp\u003eAll measurements of the area and density except for G.Med/MinM density were found to be significantly associated with TRF after adjusting for age and BMI (Table\u0026nbsp;2). What\u0026rsquo;s more, these associations were still significant after further adjusting for THaBMD (Table\u0026nbsp;2, Fig.\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e). G.Med/MinM density (adj.OR 0.98,0.95\u0026thinsp;~\u0026thinsp;1,01) was on the border associated with TRF after adjustments for age, BMI, and THaBMD.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\"\u003e\n \u003ch2\u003e3.3. Relationship between muscle variables and age\u003c/h2\u003e\n \u003cp\u003eFurthermore, we found a much stronger relationship between gluteus and TRF in the younger group (age\u0026thinsp;\u0026lt;\u0026thinsp;80) than that in the older group (age\u0026thinsp;\u0026gt;\u0026thinsp;80) (Table\u0026nbsp;2). After adjustment, all the performances of gluteus muscles were still statistically significant in the younger group (age\u0026thinsp;\u0026lt;\u0026thinsp;80) (G.Med/MinM area, 0.96 (0.92\u0026thinsp;~\u0026thinsp;0.99); G.Med/MinM density, 0.95 (0.91\u0026thinsp;~\u0026thinsp;0.98); G.MaxM area, 0.95 (0.91\u0026thinsp;~\u0026thinsp;0.99); G.MaxM density, 0.95(0.92\u0026thinsp;~\u0026thinsp;0.98)) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, Table\u0026nbsp;2, Fig.\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this cross-sectional study, we exploited CT images to obtain data on the density and area of hip muscles in acute low-energy hip fracture women, and our study showed that in older women, especially under 80 years of age, the area and density of the gluteus muscles were significantly associated with trochanteric fractures. After further adjustment for THaBMD, the associations were reduced but remained significant for most muscle parameters.\u003c/p\u003e \u003cp\u003eRegarding the differences between the two fracture subtypes (FNF and TRF) of hip fracture, a review by Mautalen et al. reported that women with TRF are older, thinner, and shorter, and the two fracture subtypes may also have different ethnic and geographic patterns[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In our study, the TRF groups were consistently older and shorter. In a case-control study, Yu et al. applied statistical multiparameter mapping to investigate spatial differences in proximal femur density and cortical bone characteristics between the two main types of hip fractures, and the results show that there were different spatial distributions of trabecular volumetric BMD between the two types of hip fractures[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, few studies have explored whether there are differences in muscle parameters between the two types of hip fractures.\u003c/p\u003e \u003cp\u003eMuscle density measured by CT as mean attenuation of skeletal muscle in Hounsfield units (HU) has already been widely used in research studies[\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] to assess muscle quality, because a low tissue HU (low muscle density) may be a marker of lipid or fluid infiltration in skeletal muscles that can be accompanied by functional changes[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Wang L et al. showed that muscle density performs better than aBMD from hip CTXA and muscle size in discrimination of hip fracture[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In 2008, Lang et al. reported that subjects with hip fractures showed trends towards lower hip muscle CSA and lower lean tissue muscle HU (reflecting greater fatty infiltration of the musculature) than controls[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Then in 2010, Lang et al. reported that decreased thigh muscle HU is associated with an increased risk of hip fracture[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. All these studies indicated that muscle density plays a vital role in assessing physical function or fracture risk[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe hypothesized that gluteal muscle density and area may be involved in classifying hip fractures in the elderly. The gluteus maximus is located in the shallow layer of the gluteal muscle, its main movement is the hip extension and external rotation, and its upper area also acts as a hip abductor muscle[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The anterior upper part of the gluteal median muscle is located under the skin, and the posterior lower part is located on the deep side of the gluteus maximus, and its primary role is to abduct the hip joint (the anterior muscle bundle rotates the hip joint, and the posterior muscle bundle rotates the hip joint out)[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The gluteus minimus muscles are located on the deep side of the gluteus medius muscle and act the same way as the gluteal median muscle, so this study analyzed these two muscles as a whole. Erin\u0026ccedil; et al. reported that the gluteal median muscle and gluteus minimus muscle areas in the FNF group are higher than those in the TRF group, but there was no significant difference in the atrophy scores between subjects with TRF versus FNF[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Our study showed that the TRF group had a smaller area of G.Med/MinM than the FNF group in women older than 65 years, which is consistent with the above study's findings. Moreover, the difference was still statistically significant after adjusting for age, BMI, and THaBMD. Furthermore, G.MaxM density and size were also associated with the risk of TRF in women older than 65 years independently of hip aBMD. Similarly, Wang L et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] showed that the G.MaxM density was significantly associated with physical performance in older women, with or without adjustment for age, height, and weight. This study revealed the important role of the G.MaxM muscle.\u003c/p\u003e \u003cp\u003eInterestingly, after we grouped patients by age 80, the difference in muscle parameters between the two fracture types in the over 80 years old group was no longer statistically significant after adjustment of covariates. However, in the 65\u0026ndash;80 age group, muscle parameters, especially G.MaxM, were more strongly related to TRF. The explanations for the age effect on muscle parameters with the risk of TRF were unclear. Hip fracture women aged over 80 years seem to be especially frail with low bone mineral density, low cortical thickness, and low muscle quality, thus, we speculated that the incidence of hip fracture type might be a random event.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first study to use a cutoff of 80 to stratify the age and further explore the age-specific relationship between G.MaxM and G.Med/MinM area and density with hip fracture type. Secondly, the subjects imaged more than 48 hours after hip fracture were excluded from our study, making our bone and muscle measurements more reliable. Moreover, several factors for binary logistic regression were calibrated in this study, including BMD, an essential factor that had been overlooked in previous relevant studies.\u003c/p\u003e \u003cp\u003eThis study has two major limitations. Firstly, this study was cross-sectional-designed, and subsequent longitudinal cohort studies are warranted further to investigate the relationship between gluteal muscles and fracture types. Secondly, in the measurement, we chose to measure the healthy side to replace the data on the fracture side, which may be biased. However, we should take into account that fracture, bleeding, edema, etc., on the fracture side may affect the accuracy of muscle parameter measurements. Meanwhile, Cheng et al.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] reflected the excellent symmetry of the hip joint on both sides and maybe it can be further improved if there is better technology in the future.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eIn conclusion, we found that in older women especially under 80, gluteus muscle parameters are related to trochanteric fractures. It is well known that age-related loss of muscle mass increases the risk of hip fractures. Therefore, maintaining muscle mass and function, as well as reducing fat infiltration in the muscles, may help prevent trochanteric fractures in older women.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFNF\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;femoral neck fractures\u003c/p\u003e\n\u003cp\u003eTRF\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003etrochanteric fractures\u003c/p\u003e\n\u003cp\u003eG.Med/MinM\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003egluteus medius and minimus muscle\u003c/p\u003e\n\u003cp\u003eG.MaxM\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;gluteus maximus muscle\u003c/p\u003e\n\u003cp\u003eTHaBMD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;total hip areal bone mineral density\u003c/p\u003e\n\u003cp\u003eFNaBMD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;femoral neck areal bone mineral density\u003c/p\u003e\n\u003cp\u003eBLR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;binary logistic regression\u003c/p\u003e\n\u003cp\u003eBMD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;bone mineral density\u003c/p\u003e\n\u003cp\u003eBMI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;body mass index\u003c/p\u003e\n\u003cp\u003eQCT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;quantitative computed tomography\u003c/p\u003e\n\u003cp\u003eCTXA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;CT X-ray absorptiometry technique\u003c/p\u003e\n\u003cp\u003eHU \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hounsfield units\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePengju Huang:\u0026nbsp;Methodology, Writing - Original Draft,\u0026nbsp;Writing- Reviewing;\u003c/p\u003e\n\u003cp\u003eYufeng Ge:\u0026nbsp;Methodology, Writing- Reviewing and Editing;\u003c/p\u003e\n\u003cp\u003eAihong Yu: Writing- Reviewing and Editing, Validation;\u003c/p\u003e\n\u003cp\u003eYandong Liu: Writing- Reviewing and Editing, Investigation, Validation;\u003c/p\u003e\n\u003cp\u003eJian Geng : Writing- Reviewing and Editing, Validation;\u003c/p\u003e\n\u003cp\u003eWei Zhang: Investigation, Validation;\u003c/p\u003e\n\u003cp\u003eWei Liang: Investigation, Validation;\u003c/p\u003e\n\u003cp\u003eXinbao Wu: Conceptualization, Methodology, Writing- Reviewing and Editing;\u003c/p\u003e\n\u003cp\u003eLing Wang: Conceptualization, Methodology, Writing- Reviewing and Editing, Supervision;\u003c/p\u003e\n\u003cp\u003eXiaoguang Cheng: Conceptualization, Methodology, Writing- Reviewing and Editing.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is supported in part by the National Key Research and Development Program of China (No. 2020YFC2004902), National Key R\u0026amp;D Program of China (2021YFC2501700), National Natural Science Foundation of China (grant no. 81971617), Beijing Hospitals Authority Youth Programme (code: 20200402), and Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (code: ZYLX202107).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Beijing Jishuitan Hospital (No.201512-02)\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing financial interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCummings SR, Melton LJ: \u003cstrong\u003eEpidemiology and outcomes of osteoporotic fractures\u003c/strong\u003e. \u003cem\u003eLancet \u003c/em\u003e2002, \u003cstrong\u003e359\u003c/strong\u003e(9319):1761-1767.\u003c/li\u003e\n\u003cli\u003evon 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study\u003c/strong\u003e. \u003cem\u003eJ Cachexia Sarcopenia Muscle \u003c/em\u003e2022, \u003cstrong\u003e13\u003c/strong\u003e(3):1927-1937.\u003c/li\u003e\n\u003cli\u003eEngelke K, Chaudry O, Bartenschlager S: \u003cstrong\u003eOpportunistic Screening Techniques for Analysis of CT Scans\u003c/strong\u003e. \u003cem\u003eCurr Osteoporos Rep \u003c/em\u003e2022.\u003c/li\u003e\n\u003cli\u003ePinto FCS, Andrade MF, Gatti da Silva GH, Faiad JZ, Barrere APN, Goncalves RC, de Castro GS, Seelaender M: \u003cstrong\u003eFunction Over Mass: A Meta-Analysis on the Importance of Skeletal Muscle Quality in COVID-19 Patients\u003c/strong\u003e. \u003cem\u003eFront Nutr \u003c/em\u003e2022, \u003cstrong\u003e9\u003c/strong\u003e:837719.\u003c/li\u003e\n\u003cli\u003eLang T, Koyama A, Li C, Li J, Lu Y, Saeed I, Gazze E, Keyak J, Harris T, Cheng X: \u003cstrong\u003ePelvic body composition measurements by quantitative computed tomography: association with recent hip fracture\u003c/strong\u003e. \u003cem\u003eBone \u003c/em\u003e2008, \u003cstrong\u003e42\u003c/strong\u003e(4):798-805.\u003c/li\u003e\n\u003cli\u003eLang T, Cauley JA, Tylavsky F, Bauer D, Cummings S, Harris TB, Health ABCS: \u003cstrong\u003eComputed tomographic measurements of thigh muscle cross-sectional area and attenuation coefficient predict hip fracture: the health, aging, and body composition study\u003c/strong\u003e. \u003cem\u003eJ Bone Miner Res \u003c/em\u003e2010, \u003cstrong\u003e25\u003c/strong\u003e(3):513-519.\u003c/li\u003e\n\u003cli\u003eCorrea-de-Araujo R, Addison O, Miljkovic I, Goodpaster BH, Bergman BC, Clark RV, Elena JW, Esser KA, Ferrucci L, Harris-Love MO\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eMyosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging\u003c/strong\u003e. \u003cem\u003eFront Physiol \u003c/em\u003e2020, \u003cstrong\u003e11\u003c/strong\u003e:963.\u003c/li\u003e\n\u003cli\u003eReiman MP, Bolgla LA, Loudon JK: \u003cstrong\u003eA literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises\u003c/strong\u003e. \u003cem\u003ePhysiother Theory Pract \u003c/em\u003e2012, \u003cstrong\u003e28\u003c/strong\u003e(4):257-268.\u003c/li\u003e\n\u003cli\u003eFlack NA, Nicholson HD, Woodley SJ: \u003cstrong\u003eA review of the anatomy of the hip abductor muscles, gluteus medius, gluteus minimus, and tensor fascia lata\u003c/strong\u003e. \u003cem\u003eClin Anat \u003c/em\u003e2012, \u003cstrong\u003e25\u003c/strong\u003e(6):697-708.\u003c/li\u003e\n\u003cli\u003eNakagawa TH, Muniz TB, Baldon Rde M, Dias Maciel C, de Menezes Reiff RB, Serrao FV: \u003cstrong\u003eThe effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study\u003c/strong\u003e. \u003cem\u003eClin Rehabil \u003c/em\u003e2008, \u003cstrong\u003e22\u003c/strong\u003e(12):1051-1060.\u003c/li\u003e\n\u003cli\u003eCheng X, Jing L, Liu X, Wang Y, Li J, Qu h, Genant H, Lang T: \u003cstrong\u003eThe study of bone mineral density and structure in proximal femur by quantitative CT in elderly Chinese women\u003c/strong\u003e. \u003cem\u003eChin J Radiol \u003c/em\u003e2009(2):126-130.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Osteoporosis, Muscle density, Muscle area, Femoral neck fracture, Trochanteric fractures","lastPublishedDoi":"10.21203/rs.3.rs-3600726/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3600726/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e We aimed to investigate the differences in hip muscle area and density between older patients with femoral neck (FNF) and trochanteric fractures (TRF).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e A total of 554 older women patients were enrolled, including 314 FNF (77.02 ± 7.15 years) and 240 TRF (79.70 ± 6.91 years) for the comparisons. The area and density of the gluteus medius and minimus muscle (G.Med/MinM) and the gluteus maximus muscle (G.MaxM) were measured by CT. Total hip (TH) areal bone mineral density (aBMD) and femoral neck aBMD (FNaBMD) were measured by quantitative CT. A cutoff of 80 years was used to stratify the cohort and to further explore the age-specific relationship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e For the total subjects, all these muscle parameters were higher in the FNF group than in the TRF group (p \u0026lt; 0.001). The muscle parameters except for the G.Med/MinM density were significantly correlated with hip fracture typing after adjustment for age, BMI, and THaBMD. In the age ≧ 80 group, no statistically significant correlation was found between all hip muscle parameters and fracture types. In contrast, in the age \u0026lt; 80 group, interestingly, after adjustment of age, BMI, and THaBMD, the associations between G.MaxM density, G.MaxM area, G.Med/MinM density, and G.Med/MinM area and fracture type were all statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e Our results indicate that in older women, especially under 80 years of age, gluteus muscle parameters are related to trochanteric fractures.\u003c/p\u003e","manuscriptTitle":"Hip muscle size and density are associated with trochanteric fractures of elderly women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-24 00:01:42","doi":"10.21203/rs.3.rs-3600726/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"74b58b4e-f0a3-465d-9fec-6abff5f08a23","owner":[],"postedDate":"November 24th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-18T06:15:07+00:00","versionOfRecord":[],"versionCreatedAt":"2023-11-24 00:01:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3600726","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3600726","identity":"rs-3600726","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}