Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly?

This prospective randomized trial compared the efficacy of unipolar versus bipolar hemiarthroplasty in elderly patients (> or = 65 years) with displaced femoral neck fractures in terms of quality of life and functional outcomes. One hundred fifteen patients with a mean age of 82.1 years were enrolled in this study and randomized to either unipolar or bipolar hemiarthroplasty. Quality of life and functional outcomes were assessed using the Musculoskeletal Functional Assessment instrument and Short Form-36 health survey. Seventy-eight patients completed 1 year of followup. There were no differences between the groups in estimated blood loss, length of hospital stay, mortality rate, number of dislocations, postoperative complications, or ambulatory status at 1 year. There also were no significant differences between the two groups at either point in postoperative Short Form-36 or Musculoskeletal Functional Assessment instrument scores. Results of this prospective randomized study suggest that the bipolar endoprosthesis provides no advantage in the treatment of displaced femoral neck fractures in elderly patients regarding quality of life and functional outcomes.     

Is the position of dual-mobility cup in THA for femoral neck fractures optimal? A retrospective study

European Journal of Orthopaedic Surgery & Traumatology - Few studies have examined the relationship between the indication of total hip arthroplasty (THA) and the quality of its technical...     

Cemented or uncemented hemiarthroplasty for the treatment of femoral neck fractures?: A Finnish database study of 25,174 patients

Background and purpose

Cemented hemiarthroplasty is preferred in treating displaced fractures of the femoral neck in the elderly. The cementing process may cause a fat embolism, leading to serious complications or death. In this study, we wanted to determine whether use of uncemented hemiarthroplasty (HA) would lead to reduced mortality and whether there are differences in the complications associated with these different types of arthroplasty.

Patients and methods

From the PERFECT database, which combines information from various treatment registries, we identified 25,174 patients who were treated with hemiarthroplasty for a femoral neck fracture in the years 1999–2009. The primary outcome was mortality. Secondary outcomes were reoperations, complications, re-admissions, and treatment times.

Results

Mortality was lower in the first postoperative days when uncemented HA was used. At 1 week, there was no significant difference in mortality (3.9% for cemented HA and 3.4% for uncemented HA; p = 0.09). This was also true after one year (26% for cemented HA and 27% for uncemented HA; p = 0.1). In patients treated with uncemented HA, there were significantly more mechanical complications (3.7% vs. 2.8%; p < 0.001), hip re-arthroplasties (1.7% vs. 0.95; p < 0.001), and femoral fracture operations (1.2% vs. 0.52%; p < 0.001) during the first 90 days after hip fracture surgery.

Interpretation

From registry data, mortality appears to be similar for cemented and uncemented HA. However, uncemented HA is associated with more frequent mechanical complications and reoperations.Displaced fractures of the femoral neck are being increasingly treated with arthroplasty instead of osteosynthesis (Rogmark et al. 2010). Hemiarthroplasty (HA) is used in most patients (Bhandari et al. 2005). The operation can be performed using either cemented or uncemented femoral components. Cemented components have been preferred, since they have been associated in meta-analyses with less postoperative pain and better mobility after surgery (Parker et al. 2010). However, these studies have mostly compared relatively outdated non-modular types of hemiarthroplasty.After the introduction of modular hemiarthroplasty to hip fracture surgery in recent years, a number of prospective trials comparing cemented and uncemented hemiarthroplasty have been published, with very similar results for both (Figved et al. 2009, DeAngelis et al. 2012, Taylor et al. 2012). However, in a recent registry study comparing (mostly modular) cemented and uncemented hemiarthroplasty, more reoperations were detected in patients treated with uncemented hemiarthroplasty (Leonardsson et al. 2012). One explanation for this discrepancy may be the relatively small sample size and incomplete follow-up associated with prospective studies (Talsnes et al. 2013).We studied mortality and results after hemiarthroplasty using Finnish registry-based data.     

Fixation of displaced femoral neck fractures in young adults: Fixed-angle devices or Pauwel screws?

BackgroundWe sought to compare the incidence of complications after fixation of displaced femoral neck fractures in young adults treated with fixed-angle devices versus multiple cancellous screws and a trochanteric lag screw (Pauwel screw).MethodsWe conducted a retrospective cohort study at a level I trauma centre. Sixty-two skeletally mature patients (age range, 16–60 years) with displaced femoral neck fractures were included in the study. Forty-seven were treated with a fixed-angle device (sliding hip plate with screw or helical blade) and 15 with multiple cancellous screws placed in a Pauwel configuration. The main outcome measure was postoperative complication of osteonecrosis or nonunion treated with a surgical procedure.ResultsSignificantly fewer failures occurred in the fixed-angle group (21%) than in the screws group (60%) (p = 0.008). Osteonecrosis was rare in the fixed-angle group, occurring in 2% of cases versus 33% of cases in the screws group (p = 0.002). Consistent with previous studies, good to excellent reductions were associated with a failure rate of 25% and fair to poor reductions were associated with a failure rate of 55% (p = 0.07). The best-case scenario of a good to excellent reduction stabilised with a fixed-angle device yielded a success rate of 85%.ConclusionIn young patients with displaced high-energy femoral neck fractures, fixed-angle devices resulted in fewer treatment failures than did Pauwel screws.     

Cephalomedullary nails in the management of ipsilateral neck and shaft fractures of the femur—One or two femoral neck screws?

This was a prospective study of 43 consecutive cases of combined ipsilateral femoral neck and shaft fractures treated with cephalomedullary nails. Sequential clinicoradiological evaluation of all high-energy femoral shaft fractures to detect associated ipsilateral neck fracture improved diagnosis. All but 1 of 35 cases included in the study achieved union of both fractures and excellent or good functional outcome. Mean Harris Hip Score at the last follow-up was 92 ± 4 in single-neck screw configurations, and 94 ± 3 for two-neck screw cephalomedullary nails which had better tip-apex distance. Mean sliding of the neck screw was 5 ± 2 mm with single-neck and 3 ± 2 mm with two-neck screw constructs. In six cases shortening was <1 cm; 22 had delayed union of the shaft fracture, but only four of these needed additional surgery. Early aggressive fixation of both fractures using a cephalomedullary nail with the least possible surgical trauma is the key to success in these polytrauma cases.     

Are patients with a nonunion after a femoral neck fracture more osteoporotic than others? BMD measurement before the choice of treatment?: A pilot study of hip BMD and biochemical bone markers in patients with femoral neck fractures

The incidence of nonunion is high after a femoral neck fracture. If reliable predictors were available, fractures that heal well could be subjected to internal fixation while fractures that do not could undergo an arthroplasty. In this pilot study of 28 patients, those with a low hip BMD on admission had a higher risk of developing non-union.     

Surgical cure for type 2 diabetes by foregut or hindgut operations: a myth or reality? A systematic review

Background

Bariatric surgery results in remission of type 2 diabetes mellitus in a significant proportion of patients. Animal research has proposed the foregut and hindgut hypotheses as possible mechanisms of remission of T2DM independent of weight loss. These hypotheses have formed the basis of investigational procedures designed to treat T2DM in non-obese (in addition to obese) patients. The aim of this study was to review the procedures that utilise the foregut and hindgut hypotheses to treat T2DM in humans.

Methods

A systematic review was conducted to identify the investigational procedures performed in humans that are based on the foregut and hindgut hypotheses and then to assess their outcomes.

Results

Twenty-four studies reported novel procedures to treat T2DM in humans; only ten utilised glycated haemoglobin A1c (HbA1c) in their definition of remission. Reported remission rates were 20–40 % for duodenal–jejunal bypass (DJB), 73–93 % for duodenal–jejunal bypass with sleeve gastrectomy (DJB-SG), 62.5–100 % for duodenal–jejunal bypass sleeve (DJBS) and 47–95.7 % for ileal interposition with sleeve gastrectomy (II-SG). When using a predetermined level of HbA1c to define remission, the remission rates were lower (27, 63, 0 and 65 %) for DJB, DJB-SG, DJBS and II-SG.

Conclusions

The outcomes of the foregut- and hindgut-based procedures are not better than the outcomes of just one of their components, namely sleeve gastrectomy. The complexity of these procedures in addition to their comparable outcomes to a simpler operation questions their utility.

     

Should insertion of intramedullary nails for tibial fractures be with or without reaming? A prospective, randomized study with 3.8 years' follow-up

OBJECTIVE: To determine if any differences exist in healing and complications between reamed and unreamed nailing in patients with tibial shaft fractures. DESIGN: Prospective, randomized. SETTING: Level 1 trauma center. PATIENTS: Forty-five patients with displaced closed and open Gustilo type I-IIIA fractures of the central two thirds of the tibia. INTERVENTION: Stabilization of tibial fractures either with a slotted, stainless steel reamed nail or a solid, titanium unreamed nail. MAIN OUTCOME MEASUREMENTS: Nonunions, time to fracture healing, and rate of malunions. RESULTS: The average time to fracture healing was 16.7 weeks in the reamed group and 25.7 weeks in the unreamed group. The difference was statistically significant (P = 0.004). There were three nonunions, all in the unreamed nail group. Two of these fractures healed after dynamization by removing static interlocking screws. The third nonunion did not heal despite exchange reamed nailing 2 years after the primary surgery and dynamization with a fibular osteotomy after an additional 1 year. There were two malunions in the reamed group and four malunions in the unreamed group. There were no differences for all other outcome measurements. CONCLUSION: Unreamed nailing in patients with tibial shaft fractures may be associated with higher rates of secondary operations and malunions compared with reamed nailing. The time to fracture healing was significantly longer with unreamed nails.     

Vitamin D levels in Irish children with fractures: A prospective case–control study with 5 year follow-up

IntroductionTwenty-five-hydroxy-vitamin D3 (25-OH-vit D) is a prohormone that is essential for normal calcium homeostasis and bone metabolism. Understanding its role is an important component of the proper care of the pediatric orthopaedic patient. The aim of this study was to determine whether children in Ireland with fractures have increased prevalence of 25-OH-Vit D deficiency compared with age matched controls and to ascertain the relationship between a low 25-OH-vit D level and the incidence of fractures in Irish children. We hypothesised that children presenting to our centre following a fracture would have significantly lower 25-OH-vit D.MethodsA prospective case–control study at a large urban tertiary referral academic hospital located in Dublin, Ireland was completed over a 14 month period from June 2014 to August 2015. A total of 116 subjects, distributed as cases (n = 58) and controls (n = 58) were included in this study. Whole blood (10 ml) was taken in two serum bottles from each patient. Serum 25-hydroxy-vitamin D3 levels were measured. An age matched control group was generated from other children attending the hospital, who also had vitamin D levels measured for different clinical reasons. We followed up both the fracture and control group for the next 5 years to assess the repeat fracture rate.ResultsFifty-eight patients with a fracture requiring operative intervention, were included in the study. Statistical analysis was performed comparing to 58 age and sex-matched controls. The mean vitamin D level for the fracture group was 63.2 nmol/L (SD = 27.3), which was higher than the mean of the controls (62.5 nmol/L) (SD = 21.3) (p = 0.86), but this difference was found not to be statistically significant in unadjusted analysis. There was no statistically significant difference in the number of patients classified with low serum Vitamin D levels (<50 nmolL), with the fracture group consisting of 22 (37.9%) patients, and the control group of 17 patients (29.3%) (p = 0.33) with a level below 50 nmol/L. At five-year follow-up, 11 of the 58 patients (18.9%) in the fracture group went on to have a further fracture compared with eight patients (13.7%) from the control group. Out of these 11 from the fracture group five (45.45%) had been found to have a low serum 25-OH-Vit D level five years previously. Out of the eight controls that presented with a fracture within the five-year period, 3 (37.5%) had had a low vitamin D level at the origin of this study.ConclusionThe results of this study show that children presenting to our institution with low energy fractures have a prevalence of 38% 25-hydroxy-vitamin D deficiency. This study included children from age 1 to 16 primarily Caucasian encompassing all fracture types resulting from accidental trauma. Our findings suggest that in an Irish pediatric population vitamin D status may impact fracture risk with more than one-third being deficient in this review.     

Undisplaced femoral neck fractures—no problems? A consecutive study of 224 patients treated with internal fixation

224 patients with undisplaced femoral neck fractures treated with two parallel Hansson hook pins were studied. After a mean follow-up time of 32 months (S.D. 5.2), 15% had a reoperation. 11% were considered failures, mostly avascular necrosis, and 9% had a secondary arthroplasty. Possible risk factors for poor outcome were analysed. Neither high age nor surgical delay was associated with increased failure rate.Survivors received a questionnaire, and 40% stated that they had mild or severe pain in the hip when walking, 25% had pain at rest and 25 stated that they thought “always” or “often” about their injury. The younger the patient, the more frequent the report of subjective pain. 51% of individuals under 80 years reported pain when walking, compared to 27% aged 80 or older (p = 0.016). Corresponding numbers for pain at rest were 32 and 12% (p = 0.034). The failure rate did not differ between the age groups, but the younger patients had more reoperations (p = 0.046) and thought more frequently about their injury (p = 0.016). An undisplaced femoral neck fracture is a major injury with a long-term daily discomfort in about 25% and clinical failure in 11%.     

Arthroplasty or internal fixation for displaced femoral neck fractures: which is the optimal alternative for elderly patients? A meta-analysis

We conducted an up-to-date meta-analysis of 20 eligible randomised controlled trials (RCTs) containing 3,109 patients to compare arthroplasty with internal fixation of displaced femoral neck fractures regarding the effect on clinical outcomes. Computerised databases were searched for RCTs published from January 1979 to May 2008. The results showed that compared to internal fixation arthroplasty led to significantly fewer surgical complications at two and five years postoperatively and reduced the incidence of reoperation at one, two and five years postoperatively (P < 0.001). However, arthroplasty was associated with greater risk of deep wound infection, longer operating time and greater operative blood loss. Arthroplasty substantially increased the risk of reoperation following deep wound infection (P < 0.05). For mortality, there was increased postoperative risk for arthroplasty compared with internal fixation, but there was no statistically significant difference between the two groups at the different follow-up times. For pain at one year postoperatively, the result showed no statistically significant difference.     

Laparoscopy or conventional open surgery for patients with ileocolonic Crohn's disease? A prospective study

BACKGROUND: Crohn's patients have been considered challenging laparoscopic candidates. The aim of this study was to analyze the short-term and long-term outcomes of laparoscopic and open surgery in consecutive patients with ileocolonic Crohn's disease. METHODS: Patients were enrolled prospectively but not randomized between August 2002 and October 2006. Patients and disease-specific characteristics, intraoperative variables, and short-term and long-term postoperative outcomes were analyzed. RESULTS: Overall, 146 consecutive patients were included in the study: 59 in the laparoscopic operation group and 87 in the open operation group. Laparoscopic patients were younger (P = .001), with a lower body mass index (BMI) (P = .008). Operative time was similar between the 2 groups. Blood loss was less in the laparoscopic group (P = .012), and postoperative blood transfusions were administered only to patients in the open group. Narcotic requirement, which was expressed as days on the IV narcotics and as morphine equivalent, was less in the laparoscopic group (P = .01). Duration of stay was less in the laparoscopic group, 5.5 versus 7.0 days, (P = .001). Using step-wise multiple regression analysis, the use of laparoscopic operation was associated with a lesser hospital stay (P < .05). Complication rates were similar, which included 1 anastomotic leak that required reoperation in each group. At a median follow-up of 19 months, there have been no disease recurrences. CONCLUSIONS: In selected patients, laparoscopy leads to a faster recovery without increasing morbidity and without compromising remission. It should be considered a safe and effective alternative to open operation.     

Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up

The aim of this long-term, prospective study was to identify risk factors associated with the outcome of clavicular fractures. During 1989 through 1991, 245 patients aged 15 years or older with a radiographically verified fracture of the clavicle were included. Clinical and radiographic examinations were standardized. Of the 208 patients seen at the 9- to 10-year follow-up, 112 (54%) had recovered completely whereas 96 (46%) still had sequelae. Nonunion occurred in 15 patients (7%). No bony contact was the strongest radiographic predictor for sequelae. Comminuted fractures with transverse fragments had a significantly increased risk for remaining symptoms, as did older patients, whereas there was no significant difference between sexes. Fracture location and shortening did not predict outcome except for cosmetic defects. Angulation of the fracture had no effect on cosmetic defects. Patients with predictive risk factors, such as fractures with no bony contact or displacement, especially if comminuted, and also elderly patients with fractures should be considered for more active treatment options.     

Is mini-open intramedullary nailing an effective intervention for adult femoral diaphyseal fractures in odd hours? A prospective case-control functional outcome and radiation safety study

BackgroundClosed intramedullary (IM) nailing among various modalities is one of the commonest sought out procedure in current practice for management of femoral-diaphyseal fractures (FDF) following trauma. However, it has some limitations like prolonged procedural duration, high radiation exposure and a steep learning curve. Therefore, with limited resources in odd hours and at a high patient turnover center where closed reduction can be a challenge, we adopted a modified mini-open technique which can overcome the limitations of closed reduction technique.PurposeTo compare the closed IM nailing and mini-open technique in FDF in terms of radiation exposure, surgical duration, radiological and functional outcome.Patients and methodsA total of 100 patients (118 femurs) with FDF (AO 32A1-B2) operated in odd-hours (20:00–06:00 hrs. GMT +5.30) with closed (Group I, n=62) or mini-open (Group II, n=56) IM nailing technique between September 2018 to December 2019 with a minimum follow up of 12 months were included in this study. The functional outcomes were measured using Thoresen scoring system and statistical analysis were performed using paired t-test and χ2 -test.ResultsThe overall mean patient age was 33.5 years (18-74 years). The mean surgical duration, c-arm shoots for reduction and radiological union time were 71.5 minutes, 21 shoots and 16 weeks, respectively for group I and 47.5 minutes, 9.4 shoots and 18 weeks for group II. There was significant difference between the two groups in mean surgical duration (p<0.05) and c-arm shoots (p<0.05). However, there was no statistical significant difference between time for union, rate of union, functional results and incidence of superficial or deep infection between the two groups.ConclusionIn conclusion, mini-open technique is a safer alternative in patients with FDF at high-volume centers and in odd-hours when the available resources are limited.     

Functional comparison between uncemented Austin-Moore hemiarthroplasty and osteosynthesis with three screws in displaced femoral neck fractures—a matched-pair study of 168 patients

There is no consensus as to whether osteosynthesis (OS) or hemiarthroplasty (HA) should be used as the primary treatment of displaced femoral-neck fracture. In a prospective matched-pair study, we compared 84 patients treated with OS with three screws and 84 patients treated with uncemented Austin-Moore HA focusing on functional parameters, reoperations and mortality. At 4 months after the fracture, functional recovery was not significantly different between the study groups. However, OS patients tended to have slightly better functional ability than HA patients, as more of them were able to walk out of doors (45.2% versus 39.2%), more were able to walk without walking aids (23.7% versus 16.7%), and more returned to live in their own homes (80%versus 72.9%). OS patients used slightly but not significantly less painkillers and had less hip pain than HA patients. OS patients had had 15.4% more reoperations by 4 months and 14.2% more by 1 year compared to the HA group. The 4-month and 1-year mortality rates of the study groups were of the same order. Functional recovery was slightly better after OS with three screws than after uncemented HA, although no significant differences were seen in a sample of this size. On the other hand, OS was associated with a higher reoperation rate.

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Résumé Il ny a aucun consensus sur le traitement initial de la fracture déplacée du col fémoral entre ostéosynthèse (OS) ou hémiarthroplastie (HA). Dans une étude prospective appariée avec focalisation sur les paramètres fonctionnels, les réinterventions et la mortalité, nous avons comparé 84 malades traités par OS avec trois vis et 84 malades traités par HA de type Austin Moore non cimentée. Quatre mois après la fracture, la récupération fonctionnelle nétait pas significativement différente entre les deux groupes de létude. Cependant, les malades OS avaient tendance à avoir une meilleure fonction que les malades HA, avec une meilleure possibilité de marche à lextérieur (45,2% contre 39,2%), de marche sans aide (23,7% contre 16,7%), et plus de retour à domicile (80% contre 7,9%). Les malades OS utilisaient, mais de façon non significative, moins dantalgiques que les malades HA et avaient moins de douleurs de hanche. Les malades OS avaient 15,4% de plus de ré-opérations à 4 mois et 14,2% dans lannée, comparés au groupe HA. Le taux de mortalité à quatre mois et à un an était du même ordre dans les deux groupes. La récupération fonctionnelle est légèrement meilleure après OS avec trois vis quaprès HA non cimenté, bien quaucune différence significative nait été relevée dans cet échantillon. En revanche, OS est associé à un taux supérieur de réinterventions.

     

Post-operative anaemia in femoral neck fracture patients: Does it need treatment? A single blinded prospective randomised controlled trial

A prospective randomised controlled trial was performed to establish the effect of oral iron supplementation on haemoglobin level at 4 weeks post-operative in elderly patients with fractured neck of femur undergoing surgical treatment. We single blindly randomised 68 patients into two groups. Thirty-four patients in the treatment group were compared with 32 in the control group. The treatment group received 200 mg of oral iron tablets 3 times a day for 4 weeks in the post-operative period compared to nothing for the control group. The groups were comparable in all other aspects. The iron treatment resulted in significantly increased haemoglobin value at 4 weeks; 0.76 g% higher than the control group (95% CI of +0.01 to +1.51) which is statistically significant (P < 0.05). There was no major complication. We recommend oral iron supplementation in elderly anaemic patients with hip fracture in the post-operative period.     

Incidence and risk factors for failure of conservative treatment for valgus impacted femoral neck fractures in elderly patients with high-risk comorbidities–A bi-center retrospective observational study

Background–Establishing the ideal indications for conservative treatment for elderly patients with valgus impacted femoral neck fractures is difficult because few studies have identified predictive factors for the failure of this treatment method. This study aimed to report the outcomes of conservative treatment for elderly patients with valgus impacted femoral neck fractures and determine risk factors that lead to treatment failure.Methods–From January 2009 to December 2018, 206 patients with valgus impacted femoral neck fracture were identified at two institutions. Elderly patients with valgus impacted femoral neck fractures corresponding to an Orthopedic Trauma Association/AO Foundation (OTA/AO) classification of 31-B1.1 or 31-B1.2 who were treated conservatively were included in the study. The following data was collected to compare the preoperative characteristics of patients with valgus impacted femoral neck fractures: age, sex, bone mineral density, medical comorbidities (hypertension, diabetes mellitus, ischemic heart disease, arrhythmia, chronic kidney disease [CKD], and stroke), medial cortex displacement, valgus angle, posterior tilt, and retroversion. These data were used to assess the independent predictors for failure of conservative treatment using multiple logistic regression analysis.Results–The failure rate after conservative treatment for valgus impacted femoral neck fracture in the enrolled patient group was 27.3% (15 of 55). CKD, presence of medial cortex displacement, high posterior tilt, and high retroversion were all identified as independent predictors for failure. The cut-off values for retroversion and posterior tilt that predicted treatment failure were 12.5° (area under curve [AUC] 0.768, p = 0.002, 95% confidence interval [CI] 0.632–0.903, sensitivity 0.733, 1-specificity 0.300) and 7.5° (AUC 0.712, p = 0.016, 95% CI 0.542- 0.881, sensitivity 0.667, 1-specificity 0.325), respectively.Conclusions–The present study showed that a high union rate could be obtained if the indications for conservative treatment in for elderly patients with valgus impacted femoral neck fractures are well-defined. Thus, we believe that conservative treatment can be a viable option for valgus impacted femoral neck fractures when elderly patients with high-risk comorbidities have acceptable fracture angulation, no medial cortex displacement, and no CKD.Level of Evidence–Level III, retrospective cohort study.     

Are radiographic indices reliable indicators for quantitative bone mineral density and vitamin D status after femoral neck fractures? A retrospective study in 112 elderly patients

Background

Radiographic parameters and indices obtained from hip x-rays are a potential tool to promptly estimate bone quality in elderly hip fracture patients. Preoperative decision in whether to use cemented or cement augmented implants might be supported by this information and thus improve patient safety. Subsequently, this study was conducted to evaluate radiographic parameters as a prescreening tool for bone quality.

Methods

A retrospective analysis of 112 elderly patients with a femoral neck fracture after low-energy trauma was performed (81 % female, 19 % male). Three radiological indices were calculated on hip x-rays: cortical index antero-posterior CTI (ap), cortical index lateral CTI (lat) and canal to calcar ratio CCR. These indices were analyzed for correlations with DXA T-Scores and serum 25-hydroxyvitamin D (25(OH)D) using the Spearman test.

Results

Median age of patients was 80 (IQR 72–86) years. A linear correlation was found for CTI (lat) and T-Score at the total hip (p?<?0.001, r?=?0.589), femoral neck (p?=?0.005, r?=?0.405) and the lumbar spine (p?=?0.002, r?=?0.299). A significant correlation was also indicated between CTI (lat) and 25(OH)D (p?=?0.002, r?=?0.293). CTI (lat) at a cut-off level of 0.4 showed a sensitivity of 79 % and a specificity of 56 % in predicting a T-score?≤??2.5 at the total hip. Gender specific analysis revealed a higher sensitivity (100 %) and specificity (73 %) of CTI (lat) at a cut-off level of 0.4 for men. For severe vitamin D deficiency (<10 ng/ml) sensitivity and specificity were 75 % and 65 %.

Conclusion

Radiographic indices as the CTI (lat) exhibit a direct correlation to BMD and serum 25OH vitamin D levels. A CTI (lat) cut-off level of 0.4 is recommended for identifying patients at risk of osteoporosis expressed by T-Scores?≤??2.5 and severe vitamin D deficiency.