Abstract Background/Aims Sarcopenia has emerged as an important determinant of fragility fractures and falls in osteoporosis. An indirect way to measure this is by estimating percentage body fat using DEXA scanning. This has not been examined in detail within different cohorts. Family history of fracture is a well-known risk factor for fragility fractures and this group has therefore been selected for this study. The objective of this research was to evaluate the effectiveness of abdominal and femoral fat percentages, alongside conventional risk factors, in predicting fracture risk in patients with a family history of fractures. Methods This was a regional, cross-sectional analysis undertaken within the North West of England. Patients referred for bone density estimation (BMD) to a DEXA scanner in this region, between 2004-2019, with a family history of fracture were studied. Statistical analysis of both categorical and continuous variables was undertaken using χ² and two-sample t-tests, respectively. Conventional predictors, alongside femoral and abdominal fat percentages, were assessed in patients with and without fractures. Results 8505 patients with a family history of fractures were selected and analysed. The mean age of our cohort was 64.02 (±8.80) years, with 7542 (88.68%) of our cohort being females and 3629 (42.67%) experiencing fractures. Our study found no significant difference in the outcome of fracture for several well-established predictors. Additionally, fractures appeared to occur more frequently in those who used steroids and smoked than those who did not, contrary to widely accepted evidence. Abdominal fat percentage did not portray statistical significance. However, higher mean left femoral fat percentage was strongly associated with increased fracture rates (P 0.001). Conclusion In patients with a family history of fracture, it appears that several traditional predictors of fracture do not perform as expected, with risk factors such as smoking and steroid use having a converse effect on fracture outcome that contradicts established findings within current literature. Our study evidences that left femoral fat percentage, which is not currently incorporated into major fracture prediction tools, is a strong indicator of fracture and should be considered when assessing fracture risk. However, larger observational studies are needed to confirm our findings. Disclosure N. Kalathas: None. M. Bukhari: None.
Kalathas et al. (2026) studied this question.