Abstract

Intertrochanteric hip fractures in elderly patients are closely linked with underlying osteoporosis, making accurate bone quality assessment critical for both treatment planning and secondary fracture prevention. This study aimed to evaluate the feasibility of using computed tomography (CT) and X-ray as complementary or alternative tools to dual-energy X-ray absorptiometry (DEXA), with a focus on the contralateral (non-fractured) hip. A retrospective analysis was conducted on 48 elderly patients (33 females, 15 males) with unilateral intertrochanteric fractures. During the non-weight-bearing period, imaging of the opposite hip was reviewed. The cortical thickness index (CTI) was calculated from pelvic anteroposterior X-rays, proximal femoral density was quantified by CT in Hounsfield Units (HU), and T- and Z-scores were obtained from DEXA. Statistical relationships between demographic variables and bone parameters were analyzed with Pearson correlation, and interhip variability was explored. CTI, HU values, and DEXA-derived scores showed significant positive correlations, confirming consistency among the methods. Lower CTI and HU values were linked with advancing age and decreased bone mineral density (BMD). Age showed a negative correlation with CT mean, CTI, and total T-scores. Height was inversely correlated with Z-scores, while weight demonstrated negative associations with multiple parameters including T-scores, Z-scores, and CTI. Strong positive correlations were identified between CTI, CT mean, and densitometric scores. CTI derived from routine pelvic X-rays and HU values from CT scans can act as practical and widely available indicators of bone quality. When combined with or used in place of DEXA, these imaging parameters may improve preoperative planning, fracture risk stratification, and early osteoporosis recognition, particularly in centers where DEXA is limited or delayed.

Key words: Intertrochanteric fractures, osteoporosis, computed tomography, dual-energy X-ray absorptiometry, cortical thickness index, bone density