Effect of dexa values on fracture of elderly patients admitted with proximal fracture of the femur

Objective: In this study, we aimed to compare the bone mineral density of the patients with advanced age femoral proximal fracture who applied to our clinic and the values of the patients whose bone mineral density was measured with the pre-diagnosis of osteoporosis in our hospital and to examine the effect on the fracture. Materials and Methods: This retrospective study was planned to examine elderly patients who underwent DEXA with the pre-diagnosis of osteoporosis between 01.01.2022 and 25.10.2023 in the Orthopedics and Traumatology Clinic of Dicle University Faculty of Medicine and were treated with the diagnosis of proximal femoral fracture. After the approval of the ethics was obtained, the patients were divided into two groups according to the presence of fracture: Group 1; elderly patients who applied with proximal femoral fracture, Group 2; patients who underwent DEXA with the pre-diagnosis of osteoporosis without fracture. No additional laboratory and imaging studies were performed on the patients during routine outpatient clinic controls. Results: 2484 patients were included in our study. 440 of the patients presented with a proximal femoral fracture and the mean age was 71.11±8.07 years. Of these patients, 228 were female and 212 were male. The mean age of women admitted with fractures was 72.30±7.79 years. The mean age of the males admitted with fractures was 69.83 ±8.24 years. 2044 of the patients had no fractures and underwent DEXA with the preliminary diagnosis of osteoporosis. The mean age was 70.45±5.94 years. Of these patients, 1396 were female and 648 were male. The mean age of women was 71.07±5.72, and the mean age of men was 69.12±6.19 years. Spine, neck, trochanteric, intertrochanteric, total and ward's T-scores of the DEXA values of the patients presenting with femoral proximal fracture were found to be higher than the values of the control group (p=0.017 for spine, p=0.000 for each other). ROC analyzes were performed. The ability of spine, neck, trochanteric, intertrochanteric, total and ward's T-score values to predict fracture development was calculated as 0.547, 0.733, 0.751, 0.793, 0.79 and 0.658 cutoff values -2.15, -2.05, -1.55, -0.95, -1.05 and -1.95, sensitivity 56%, 69%, 71%, 73%, 72% and 62% specificity 52%, 68%, 70%, 71%, 72% and 63%, respectively. Spine T-score values were found to be insignificant when compared between the female patients of the femoral proximal fracture group and the control group (p=0.213). Neck, trochanteric, intertrochanteric, total and ward's T-score values were found to be highly significant (p=0.000 for each). ROC analyzes were performed. The ability of spine, neck, trochanteric, intertrochanteric, total and ward's T- score values to predict fracture development was calculated as 0.539, 0.755, 0.781, 0.765, 0.786 and 0.681 cut-off values -2.25, -2.15, -1.55, -0.85, -0.95 and -2.05% sensitivity 56%, 70%, 73%, 70%, 72% and 63% specificity 52%, 70%, 73%, 65%, 69% and 66%, respectively. Spine Tscore, neck, trochanteric, intertrochanteric, total and ward's T-score values were found to be highly significant between the male patients of the group with proximal femoral fracture and the male patients of the control group (p=0.000 for each). ROC analyzes were performed. The ability of spine, neck, trochanteric, intertrochanteric, total and ward's T-score values to predict fracture development was calculated as 0.606, 0.720, 0.706, 0.831, 0.793 and 0.647 cut-off values -1.75, -1.75, -1.65, -1.15 and -1.75, sensitivity 56%, 67%, 67%, 79%, 73% and 64%, specificity 53%, 62%, 67%, 79%, 75% and 58%, respectively. Conclusion: Clinicians make diagnosis, treatment and follow-up based on the patient's smallest T-score. In our study, although DEXA was not the smallest value, it was observed that some values were much more significant, sensitive and specific in terms of determining fracture risk. It can be thought that using these values may be more useful in the diagnosis, treatment and follow-up of the disease. In addition, it can be thought that using DEXA values with high sensitivity and specificity alone or instead of the neck T-score value used in the FRAX score will improve the fracture risk estimation. Keywords: Osteoporosis, DEXA, Proximal Femur Fractures