Hip Fractures Risk in Older Men and Women Associated With DXA-Derived Measures of Thigh Subcutaneous Fat Thickness, Cross-Sectional Muscle Area, and Muscle Density. Malkov, S.; Cawthon, P. M.; Peters, K. W.; Cauley, J. A.; Murphy, R. A.; Visser, M.; Wilson, J. P.; Harris, T.; Satterfield, S.; Cummings, S.; Shepherd, J. A.; and Health ABC Study Journal of Bone and Mineral Research: The Official Journal of the American Society for Bone and Mineral Research, 30(8):1414–1421, August, 2015.
doi  abstract   bibtex   
Mid-thigh cross-sectional muscle area (CSA), muscle attenuation, and greater trochanter soft tissue thickness have been shown to be independent risk factors of hip fracture. Our aim was to determine whether muscle and adipose tissue measures derived from dual-energy X-ray absorptiometry (DXA) scans would have a similar risk association as those measured using other imaging methods. Using a case-cohort study design, we identified 169 incident hip fracture cases over an average of 13.5 years among participants from the Health ABC Study, a prospective study of 3075 individuals initially aged 70 to 79 years. We modeled the thigh 3D geometry and compared DXA and computed tomography (CT) measures. DXA-derived thigh CSA, muscle attenuation, and subcutaneous fat thickness were found to be highly correlated to their CT counterparts (Pearson's r = 0.82, 0.45, and 0.91, respectively; p \textless 0.05). The fracture risk of men and women were calculated separately. We found that decreased subcutaneous fat, CT thigh muscle attenuation, and appendicular lean mass by height squared (ALM/Ht(2)) were associated with fracture risk in men; hazard ratios (HR) = 1.44 (1.02, 2.02), 1.40 (1.05, 1.85), and 0.58 (0.36, 0.91), respectively, after adjusting for age, race, clinical site, body mass index (BMI), chronic disease, hip bone mineral density (BMD), self-reported health, alcohol use, smoking status, education, physical activity, and cognitive function. In a similar model for women, only decreases in subcutaneous fat and DXA CSA were associated with hip fracture risk; HR = 1.39 (1.07, 1.82) and 0.78 (0.62, 0.97), respectively. Men with a high ALM/Ht(2) and low subcutaneous fat thickness had greater than 8 times higher risk for hip fracture compared with those with low ALM/Ht(2) and high subcutaneous fat. In women, ALM/Ht(2) did not improve the model when subcutaneous fat was included. We conclude that the DXA-derived subcutaneous fat thickness is a strong marker for hip fracture risk in both men and women, especially in men with high ALM/Ht(2).
@article{malkov_hip_2015,
	title = {Hip {Fractures} {Risk} in {Older} {Men} and {Women} {Associated} {With} {DXA}-{Derived} {Measures} of {Thigh} {Subcutaneous} {Fat} {Thickness}, {Cross}-{Sectional} {Muscle} {Area}, and {Muscle} {Density}},
	volume = {30},
	issn = {1523-4681},
	doi = {10.1002/jbmr.2469},
	abstract = {Mid-thigh cross-sectional muscle area (CSA), muscle attenuation, and greater trochanter soft tissue thickness have been shown to be independent risk factors of hip fracture. Our aim was to determine whether muscle and adipose tissue measures derived from dual-energy X-ray absorptiometry (DXA) scans would have a similar risk association as those measured using other imaging methods. Using a case-cohort study design, we identified 169 incident hip fracture cases over an average of 13.5 years among participants from the Health ABC Study, a prospective study of 3075 individuals initially aged 70 to 79 years. We modeled the thigh 3D geometry and compared DXA and computed tomography (CT) measures. DXA-derived thigh CSA, muscle attenuation, and subcutaneous fat thickness were found to be highly correlated to their CT counterparts (Pearson's r = 0.82, 0.45, and 0.91, respectively; p {\textless} 0.05). The fracture risk of men and women were calculated separately. We found that decreased subcutaneous fat, CT thigh muscle attenuation, and appendicular lean mass by height squared (ALM/Ht(2)) were associated with fracture risk in men; hazard ratios (HR) = 1.44 (1.02, 2.02), 1.40 (1.05, 1.85), and 0.58 (0.36, 0.91), respectively, after adjusting for age, race, clinical site, body mass index (BMI), chronic disease, hip bone mineral density (BMD), self-reported health, alcohol use, smoking status, education, physical activity, and cognitive function. In a similar model for women, only decreases in subcutaneous fat and DXA CSA were associated with hip fracture risk; HR = 1.39 (1.07, 1.82) and 0.78 (0.62, 0.97), respectively. Men with a high ALM/Ht(2) and low subcutaneous fat thickness had greater than 8 times higher risk for hip fracture compared with those with low ALM/Ht(2) and high subcutaneous fat. In women, ALM/Ht(2) did not improve the model when subcutaneous fat was included. We conclude that the DXA-derived subcutaneous fat thickness is a strong marker for hip fracture risk in both men and women, especially in men with high ALM/Ht(2).},
	language = {eng},
	number = {8},
	journal = {Journal of Bone and Mineral Research: The Official Journal of the American Society for Bone and Mineral Research},
	author = {Malkov, Serghei and Cawthon, Peggy M. and Peters, Kathy Wilt and Cauley, Jane A. and Murphy, Rachel A. and Visser, Marjolein and Wilson, Joseph P. and Harris, Tamara and Satterfield, Suzanne and Cummings, Steve and Shepherd, John A. and {Health ABC Study}},
	month = aug,
	year = {2015},
	pmid = {25644748},
	pmcid = {PMC5111546},
	keywords = {AGING, Absorptiometry, Photon, Aged, BODY COMPOSITION, DUAL-ENERGY X-RAY ABSORPTIOMETRY, Female, HIP FRACTURE, Hip Fractures, Humans, Male, Models, Biological, Muscle, Skeletal, OSTEOPOROSIS, Prospective Studies, Risk Factors, SKELETAL MUSCLE ATTENUATION, Subcutaneous Fat},
	pages = {1414--1421}
}
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