Frailty, Hip Fracture, Muscle, Sarcopenia
Conditions
Keywords
Regional Muscle Balance, Gluteus Medius, Psoas Muscle, CT-Based Muscle Measurement, Hip Fracture Pattern, Geriatric Fracture, Musculoskeletal Biomechanics
Brief summary
Hip fractures are common in older adults and are often associated with muscle loss and frailty. While many studies focus on overall muscle reduction (sarcopenia), the role of regional muscle balance around the hip remains unclear. This prospective observational study aims to evaluate whether differences in muscle distribution, particularly between the gluteus medius and psoas muscles measured using computed tomography (CT), are associated with different hip fracture patterns. The study also investigates the potential effects of socioeconomic status, nutritional risk, and comorbidity burden on fracture configuration. Understanding how regional muscle characteristics relate to hip fracture types may provide new insight into biomechanical mechanisms and support future prevention and rehabilitation strategies for older adults.
Detailed description
Hip fractures represent a major cause of morbidity and mortality in the aging population and are frequently associated with sarcopenia and frailty. Although previous studies have primarily focused on global muscle mass reduction, the biomechanical relevance of regional muscle distribution surrounding the hip joint has not been sufficiently investigated. This prospective observational study evaluates the association between regional muscle balance and hip fracture patterns in older adults using CT-based muscle measurements. Participants aged 60 years and older presenting with hip fractures following low-energy falls were included. Demographic characteristics, socioeconomic status, nutritional risk assessed by the Geriatric Nutritional Risk Index (GNRI), and comorbidity burden measured by the Charlson Comorbidity Index were recorded. Cross-sectional muscle areas, including total skeletal muscle, bilateral psoas muscle, and gluteus medius muscle, were measured on standardized CT images. The gluteus-to-psoas ratio was calculated to assess regional muscle distribution. The primary objective of the study is to determine whether CT-based regional muscle characteristics are associated with hip fracture configuration, specifically intertrochanteric and femoral neck fractures. Secondary objectives include evaluating the potential influence of nutritional and socioeconomic factors on fracture patterns. Findings from this study may improve understanding of hip fracture biomechanics and contribute to future risk stratification and individualized rehabilitation approaches.
Interventions
None listed
Sponsors
Ankara City Hospital Bilkent
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥60 years * Presentation with hip fracture following a low-energy fall * Availability of pelvic computed tomography (CT) imaging at admission * Ability to provide written informed consen
Exclusion criteria
* Pathological fractures * Active malignancy * Subtrochanteric fractures (≥5 cm distal to the lesser trochanter) * High-energy trauma * Neuromuscular disorders affecting muscle morphology * Inflammatory systemic diseases * Hemiparesis secondary to cerebrovascular events * Refusal to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hip Fracture Pattern | Baseline (at admission) | Fracture configuration classified based on radiographic evaluation at hospital admission. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Gluteus-to-Psoas Ratio | Baseline | CT-derived ratio of gluteus medius area to total psoas muscle area. |
| Total Psoas Muscle Area | Baseline | Cross-sectional area measured on CT at L3 level. |
| Gluteus Medius Muscle Area | Baseline | Cross-sectional area measured at inferior sacroiliac joint level. |
| Appendicular Skeletal Muscle Mass Index (ASMI) | Baseline | Appendicular skeletal muscle mass index calculated from CT-based cross-sectional muscle area normalized to height squared (cm²/m²). Lower values indicate reduced skeletal muscle mass consistent with sarcopenia. There is no fixed theoretical maximum value; values depend on individual body composition. Higher values reflect greater muscle mass. Minimum: 0 Maximum: Not predefined (continuous variable) |
| Psoas Muscle Index (PMI) | Baseline | Height-adjusted psoas muscle cross-sectional area (cm²/m²) measured at the L3 vertebral level on CT imaging. Lower values indicate lower muscle mass and potential sarcopenia. Higher values reflect greater psoas muscle mass. Minimum: 0 Maximum: Not predefined (continuous variable) |
| Geriatric Nutritional Risk Index (GNRI) | Baseline | The Geriatric Nutritional Risk Index (GNRI) is a nutritional risk assessment score calculated using serum albumin levels and the ratio of actual to ideal body weight. Higher scores indicate better nutritional status, whereas lower scores indicate increased nutritional risk. Minimum: Theoretical minimum approximately 0 Maximum: Not predefined (typically \>100 in well-nourished individuals) Higher score = better nutritional status Lower score = worse outcome (higher nutritional risk) |
| Charlson Comorbidity Index (CCI) | Baseline | The Charlson Comorbidity Index (CCI) is a weighted score used to predict mortality risk based on comorbid conditions. Age-adjusted CCI includes additional points based on age. Higher scores indicate greater comorbidity burden and higher predicted mortality risk. Minimum: 0 Maximum: Not fixed (depends on number of comorbidities) Higher score = worse health status Lower score = better health status |
| Socioeconomic Status (Income Level and Residence) | Baseline | Income category and residence classification (urban/rural). |
Countries
Turkey (Türkiye)
Outcome results
None listed