Hip structural geometry in old and old-old age: Similarities and differences between men and women

Introduction: Changes in hip structure and geometry during aging contribute to decreased bone strength. Little is known, however, about these characteristics at advanced age, when fragility fractures are common. We examined hip structural geometry in men and women of old age (72-84 years) and old-old age (85-96 years) to determine (1) gender differences; (2) whether or not these differences are consistent with the increased occurrence of hip fracture in elderly women, compared to men; and (3) whether or not gender-specific changes are consistent with the increased occurrence of fragility fractures after age 80 in both men and women. Methods: We used Hip Structure Analysis (HSA) software to analyze bone densitometry scans from 916 community-dwelling men and women aged 72-96 years. We examined gender differences in hip geometry by age group (72-74, 75-79, 80-84, and ≥ 85 years) and between gender-specific age groups using multivariable linear regression. Results: At the femoral narrow neck, there was no gender difference at age 72-74 in bone mineral density (BMD), cortical thickness (CT), and buckling ratio (BR). In contrast, at age 85 or older women had 13% less BMD and CT than men and 8% higher BR. At the intertrochanteric region, women ≥ 85 years had 25-31% less BMD, cross-sectional bone area (CSA), and CT than men of comparable age, and 38% higher BR. These gender differences were approximately 10-20% greater than those between men and women in their 70s. In gender-specific comparisons, women showed increasing change in structural geometry with increasing age. At both narrow neck and trochanteric regions, women ≥ 85 years had nearly 35% higher BR, 15% less BMD and CT, and 10% less CSA than women aged 72-74 years. At the narrow neck, they also had 6% greater outer diameter than the youngest women and 8% lower section modulus (Z), an index of bending strength. In contrast, men showed significant age differences only at the narrow neck region, and only at 85 years or older, including 22% higher BR, 10% less BMD and CT, and 5% greater outer diameter, compared to men in their early 70s. Unlike women, men showed no age-associated decline in section modulus. Conclusions: Gender differences in hip geometry consistent with increased fragility and fracture risk in elderly women, compared to men, continue into old-old age. Both men and women 85 or older show the most unfavorable features, suggesting a structural basis for the increased occurrence of hip fracture in both sexes at advanced age.