Abstract
AIMS: To explore the influence of both sexes on the relationship between the size and density of paravertebral muscle and subcutaneous adipose tissue (SAT) and the bone mineral density (BMD) of the proximal femur in elderly patients with hip fractures (HF). METHODS: Quantitative computed tomography was conducted on the hip joints and lumbar vertebrae of 218 elderly patients with low-energy acute HF to assess the areal BMD (aBMD) of the proximal femur. Additionally, the cross-sectional area and density of the psoas muscle, the spinal extensor muscles (EM) at the L3 level, and the surrounding SAT were measured. Multivariable linear regression models were employed to examine the relationships among bone, muscle, and SAT across different genders. RESULTS: The psoas density, EM area, EM density, and various aBMDs in the femoral neck fracture (FNF) group were significantly higher than those in the intertrochanteric fracture (ITF) group (P < 0.05), while the age and SAT density were significantly lower in the FNF group compared to the ITF group (P < 0.05). After adjusting for age and BMI covariates in the FNF group, TH aBMD was not correlated with EM area in male patients; however, the remaining paravertebral muscles and SAT were significantly correlated with TH aBMD (P < 0.05). Among female patients, aBMD in each part was positively correlated with EM area (P < 0.05). Furthermore, the TR aBMD of female patients was negatively correlated with SAT density (B, -3.689; 95% CI, -7.202- -0.177; P = 0.040). In the ITF group, there was no significant correlation between the parameters of muscle and SAT and the BMD of the proximal femur for both males and females (P > 0.05). CONCLUSIONS: In the FNF group, the size of the lumbar paravertebral EM in elderly women, rather than their density, was positively correlated with the BMD parameters of the proximal femur. The size of the lumbar paravertebral EM may serve as a more clinically significant target for preventing FNF in elderly women.