Femoral radiographic indices for pre-operative osteoporosis screening in postmenopausal female patients undergoing total hip arthroplasty for osteoarthritis

by Masanori Nishi, Yasushi Yoshikawa, Yuki Usui, Hajime Nishida, Shota Nakamura, Koichiro Tashiro, Yoshifumi Kudo

The purpose of this study was to investigate the correlation between femoral morphological indices from anteroposterior hip radiographs and dual-energy X-ray absorptiometry-assessed bone mineral density in postmenopausal female patients undergoing primary total hip arthroplasty for hip osteoarthritis. We also evaluated the impact of hip deformity on these correlations and the diagnostic cut-off values for osteoporosis. This retrospective study, conducted at a single institute (February 2018 to July 2024), reviewed the data of postmenopausal patients (>50 years old) with hip osteoarthritis who underwent total hip arthroplasty. Patients with a history of hip surgical procedures, infection, metabolic bone disease, or inadequate imaging findings were excluded. Dual-energy X-ray absorptiometry was used to assess bone mineral density at the femoral neck, total hip, lumbar spine, and distal radius. Five femoral indices were measured: the canal-to-calcar ratio, canal flare index, cortical thickness index, canal diaphysis ratio, and canal bone area ratio. Analyses included Pearson’s correlation and receiver operating characteristic curve analysis. Moderate correlations were observed between total hip bone mineral density and indices in 95 hip osteoarthritic joints (all Tönnis grade 3) and 86 normal joints. The canal bone area ratio had the strongest correlation (hip osteoarthritis: r = −0.61; normal: r = −0.62; p 

Serum albumin and gamma gap levels, and combined effect for risk of mortality in a Japanese population from the J-MICC study

by Kenichi Shibuya, Rie Ibusuki, Daisaku Nishimoto, Shiroh Tanoue, Chihaya Koriyama, Shuhei Niiyama, Yasuyuki Kakihana, Toshiro Takezaki, Megumi Hara, Yuichiro Nishida, Sadao Suzuki, Takeshi Nishiyama, Mako Nagayoshi, Takashi Tamura, Yudai Tamada, Rieko Okada, Teruhide Koyama, Satomi Tomida, Kiyonori Kuriki, Jun Otonari, Hiroaki Ikezaki, Asahi Hishida, Masashi Ishizu, Sakurako Katsuura-Kamano, Kenji Wakai, Keitaro Matsuo, for the J-MICC Study group

Although the clinical importance of serum albumin and gamma gap levels is well established, it is unclear how these levels are associated with health risks in the general population. This cohort study aimed to clarify the association between serum albumin and gamma gap levels, and their combined effect, and mortality risk in a Japanese population. The participants totaled 35,746 (17,160 men and 18,586 women) aged 35–69 years from the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study. The mean follow-up period was 11.8 years, with 1,529 deaths and 1,907 censoring. The Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals after adjusting for related factors. Increased HRs of low albumin and high gamma gap levels were respectively observed for deaths from all-causes, cancer, cardiovascular diseases, respiratory system diseases without pneumonia, and other-causes; and the HR was the highest on respiratory system diseases without pneumonia (HR = 7.31, 4.15–12.9). Low albumin and low gamma gap levels were strongly associated for pneumonia death (HR = 12.4, 3.98–38.5). The interaction between albumin and gamma gap levels was significant for deaths from all-causes, pneumonia and other-causes. The dose relationship for each association was dose-dependent in albumin and threshold-type in gamma gap, except for other-causes. This study suggests that albumin and gamma gap levels are independent indicators of an increased risk of mortality in a Japanese population. Combined effect was apparent for mortality from all-causes, pneumonia, and other-causes.