Body mass index as a prognostic factor for fracturing of the proximal extremity of the femur: a case-control study

Pagani, Renato Cavanus; Kunz, Rodrigo Ernesto; Girardi, Ricardo; Guerra, Marcelo

doi:10.1016/j.rboe.2014.09.004

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Original Article • Rev. bras. ortop. 49 (5) • Sep-Oct 2014 • https://doi.org/10.1016/j.rboe.2014.09.004 copy

Body mass index as a prognostic factor for fracturing of the proximal extremity of the femur: a case-control study^☆ ☆ Please cite this article as: Pagani RC, Kunz RE, Girardi R, Guerra M. Índice de massa corporal como fator prognóstico para fratura da extremidade proximal do fêmur: um estudo de caso-controle. Rev Bras Ortop. 2014;49(5):461–7. ,^☆☆ ☆☆ Work developed at Hospital Independência, Hospital Beneficência Portuguesa and ULBRA University Hospital, Canoas, RS, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives:

To compare the body mass index (BMI) of patients with fractures in the proximal extremity of the femur with the BMI of patients without any previous history of fractures.

Methods:

We investigated patients of both sexes, aged 65 years or over, who were admitted to Hospital Independência, Hospital Beneficência Portuguesa or ULBRA University Hospital, between December 2007 and December 2010, with histories of low-energy trauma such as falling from a standingposition. These individuals were compared with patients of the same age but without any history of fracturing of the proximal extremity of the femur (n = 89), who were attended at the geriatrics outpatient clinic of the Sociedade Porto-Alegrense de Auxílio aos Necessitados (SPAAN).

Results:

The age group of the patients with fractures in the proximal extremity of the femur ranged from 65 to 96 years (mean: 77.58). The main type of fracture was trochanteric (47; 62.2%), followed by femoral neck fractures (27; 36%). Among the patients who presented on fracturing the proximal extremity of the femur, 12% had low weight, 62.7% normal weight, 24% overweight, and 1.3% obesity. Among the patients without any history of fractures, 5.6% presented low weight, 43.8% normal weight, 33.7% overweight, and 9.8% obesity. It was observed that the patients with fractures in the proximal extremity of the femur (n = 75) presented a mean BMI of 22.6, while the patients without fractures presented a mean BMI of 25.5.

Conclusion:

The patients in the group with fractures were significantly taller than those in the group without fractures and presented significantly lower BMI than those in the group without fractures.

Hip fracture; Elderly person; Body mass index

Variable	Category	Group(%)		Total	p ^a a p value (significance level). For associations to be considered significant, the p value needed to be a maximum of 5% (p ≤ 0.05).
Variable	Category	With fractures	Without fractures	Total
Sex	Female	74.7	62.9	68.3	0.107
Sex	Male	25.3	37.1	31.7
Age	Up to 70 years	17.3	14.6	15.9	0.864
	From 71 to 80 years	45.3	44.9	45.1
	Over 80 years	37.3	40.4	39.0

Variable	Group	n	Mean	Standard deviation	p
Age	With fractures	75	77.6	7.6	0.491 (NS)
Age	Without fractures	89	78.4	7.3
Height	With fractures	75	1.62	0.11	0.000^a a Significant at the significance level of p ≤ 0.0001.
Height	Without fractures	89	1.54	0.09
Weight	With fractures	75	59.7	13.2	0.784 (NS)
Weight	Without fractures	89	60.3	13.5
BMI	With fractures	75	22.6	3.9	0.000^a a Significant at the significance level of p ≤ 0.0001.
BMI	Without fractures	89	25.5	5.3

BMI classification	Group (%)		Total	p
BMI classification	With fractures	Without fractures	Total	p
Low weight	12.0	5.6	8.5	0.003^a a Significant at the significance level of p ≤ 0.01. To perform the test on the BMI variable, the categories of overweight and obesity were grouped.
Normal weight	62.7	43.8	52.4
Overweight	24.0	33.7	29.3
Obese	1.3	16.9	9.8

Variable	Category	Type of fracture			p
Variable	Category	Femoral neck	Subtrochanteric	Trochanteric	p
Sex	Female	70.4	100.0	76.6	0.693(NS)
Sex	Male	29.6		23.4
Age	Up to 70 years	33.3		8.5	0.010^a a Significant at the significance level of p ≤ 0.01.
	From 71 to 80 years	48.1		44.7
	Over 80 years	18.5	100.0	46.8
BMI classification^b b To perform the test on the BMI variable, the categories of overweight and obesity were grouped.	Low weight	14.8		10.6	0.256(NS)
	Normal weight	70.4		59.6
	Overweight/obese	14.8	100.0	29.8

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[1] *Corresponding author. E-mail: digokunz@yahoo.com.br (R.E. Kunz).