Regional hip bone density patterns in femoral neck and intertrochanteric fractures: a single-center retrospective study of 500 older adults in midtown Shanghai

Hip fragility fractures in older adults commonly present as femoral neck or intertrochanteric fractures, which may reflect different regional deficits in proximal femoral bone mineral density (BMD). This study assessed whether QCT-derived regional hip BMD patterns can distinguish femoral neck from intertrochanteric fragility fractures. Retrospective analysis of 500 patients aged ≥65 years (2020–2024). QCT-derived T-scores for femoral neck (FN), trochanter (FT), intertrochanter (IT), and total hip (TH) were evaluated. Multivariable logistic regression (age, sex, FT T-score, TH T-score) identified predictors; a point-based score was derived. Fracture types: 277 femoral neck, 223 intertrochanteric; mean age 80.2±7.7 years. Intertrochanteric cases were older (82.6±7.2 vs 78.3±7.5, p<0.01) with lower regional T-scores (all p<0.01). FT T-score was the strongest discriminator (OR 0.19, 95% CI 0.11–0.35, p<0.001). Higher TH T-score paradoxically associated with intertrochanteric fractures (OR 2.16, 95% CI 1.35–3.44, p=0.001), indicating focal trochanteric deficit relative to preserved composite density. Men with intertrochanteric fractures showed localized trochanteric loss; women demonstrated more diffuse decline. Final model AUC 0.747 (95% CI 0.704–0.791). QCT-derived regional hip T-score patterns, particularly the trochanteric T-score, help differentiate femoral neck from intertrochanteric fragility fractures. The discordance between low trochanteric and relatively preserved total hip density may provide a useful phenotype for fracture characterization and risk stratification.