Regional Muscle Balance and Hip Fracture Patterns

February 28, 2026 updated by: Omer Faruk Naldoven, Ankara City Hospital Bilkent

Regional Muscle Balance Rather Than Global Sarcopenia Is Associated With Hip Fracture Patterns: A Prospective CT-Based Comparative Study

Hip fractures are common in older adults and are often associated with muscle loss and frailty. While many studies focus on overall muscle reduction (sarcopenia), the role of regional muscle balance around the hip remains unclear. This prospective observational study aims to evaluate whether differences in muscle distribution, particularly between the gluteus medius and psoas muscles measured using computed tomography (CT), are associated with different hip fracture patterns. The study also investigates the potential effects of socioeconomic status, nutritional risk, and comorbidity burden on fracture configuration. Understanding how regional muscle characteristics relate to hip fracture types may provide new insight into biomechanical mechanisms and support future prevention and rehabilitation strategies for older adults.

Study Overview

Status

Completed

Conditions

Detailed Description

Hip fractures represent a major cause of morbidity and mortality in the aging population and are frequently associated with sarcopenia and frailty. Although previous studies have primarily focused on global muscle mass reduction, the biomechanical relevance of regional muscle distribution surrounding the hip joint has not been sufficiently investigated. This prospective observational study evaluates the association between regional muscle balance and hip fracture patterns in older adults using CT-based muscle measurements.

Participants aged 60 years and older presenting with hip fractures following low-energy falls were included. Demographic characteristics, socioeconomic status, nutritional risk assessed by the Geriatric Nutritional Risk Index (GNRI), and comorbidity burden measured by the Charlson Comorbidity Index were recorded. Cross-sectional muscle areas, including total skeletal muscle, bilateral psoas muscle, and gluteus medius muscle, were measured on standardized CT images. The gluteus-to-psoas ratio was calculated to assess regional muscle distribution.

The primary objective of the study is to determine whether CT-based regional muscle characteristics are associated with hip fracture configuration, specifically intertrochanteric and femoral neck fractures. Secondary objectives include evaluating the potential influence of nutritional and socioeconomic factors on fracture patterns. Findings from this study may improve understanding of hip fracture biomechanics and contribute to future risk stratification and individualized rehabilitation approaches.

Study Type

Observational

Enrollment (Actual)

79

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • Çankaya
      • Ankara, Çankaya, Turkey (Türkiye), 06800
        • Ankara Bilkent City Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Older adults aged 60 years and older presenting with hip fractures after low-energy falls were prospectively enrolled. Participants were evaluated in a tertiary care orthopedic trauma center, and fracture types were classified as femoral neck fracture or intertrochanteric femur fracture. All participants underwent standardized clinical assessment and CT-based muscle measurements at admission.

Description

Inclusion Criteria:

  • Age ≥60 years
  • Presentation with hip fracture following a low-energy fall
  • Availability of pelvic computed tomography (CT) imaging at admission
  • Ability to provide written informed consen

Exclusion Criteria:

  • Pathological fractures
  • Active malignancy
  • Subtrochanteric fractures (≥5 cm distal to the lesser trochanter)
  • High-energy trauma
  • Neuromuscular disorders affecting muscle morphology
  • Inflammatory systemic diseases
  • Hemiparesis secondary to cerebrovascular events
  • Refusal to participate in the study

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Femoral Neck Fracture (FNF)
Older adults (≥60 years) with hip fracture classified as femoral neck fracture after low-energy fall; CT-based muscle measurements and clinical variables were assessed.
Intertrochanteric Femur Fracture (ITFF)
Older adults (≥60 years) with hip fracture classified as intertrochanteric femur fracture after low-energy fall; CT-based muscle measurements and clinical variables were assessed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Hip Fracture Pattern
Time Frame: Baseline (at admission)
Fracture configuration classified based on radiographic evaluation at hospital admission.
Baseline (at admission)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Gluteus-to-Psoas Ratio
Time Frame: Baseline
CT-derived ratio of gluteus medius area to total psoas muscle area.
Baseline
Total Psoas Muscle Area
Time Frame: Baseline
Cross-sectional area measured on CT at L3 level.
Baseline
Gluteus Medius Muscle Area
Time Frame: Baseline
Cross-sectional area measured at inferior sacroiliac joint level.
Baseline
Socioeconomic Status (Income Level and Residence)
Time Frame: Baseline
Income category and residence classification (urban/rural).
Baseline
Appendicular Skeletal Muscle Mass Index (ASMI)
Time Frame: Baseline

Appendicular skeletal muscle mass index calculated from CT-based cross-sectional muscle area normalized to height squared (cm²/m²).

Lower values indicate reduced skeletal muscle mass consistent with sarcopenia. There is no fixed theoretical maximum value; values depend on individual body composition. Higher values reflect greater muscle mass.

Minimum: 0 Maximum: Not predefined (continuous variable)
Baseline
Psoas Muscle Index (PMI)
Time Frame: Baseline

Height-adjusted psoas muscle cross-sectional area (cm²/m²) measured at the L3 vertebral level on CT imaging.

Lower values indicate lower muscle mass and potential sarcopenia. Higher values reflect greater psoas muscle mass.

Minimum: 0 Maximum: Not predefined (continuous variable)
Baseline
Geriatric Nutritional Risk Index (GNRI)
Time Frame: Baseline

The Geriatric Nutritional Risk Index (GNRI) is a nutritional risk assessment score calculated using serum albumin levels and the ratio of actual to ideal body weight.

Higher scores indicate better nutritional status, whereas lower scores indicate increased nutritional risk.

Minimum: Theoretical minimum approximately 0 Maximum: Not predefined (typically >100 in well-nourished individuals)

Higher score = better nutritional status Lower score = worse outcome (higher nutritional risk)
Baseline
Charlson Comorbidity Index (CCI)
Time Frame: Baseline

The Charlson Comorbidity Index (CCI) is a weighted score used to predict mortality risk based on comorbid conditions. Age-adjusted CCI includes additional points based on age.

Higher scores indicate greater comorbidity burden and higher predicted mortality risk.

Minimum: 0 Maximum: Not fixed (depends on number of comorbidities)

Higher score = worse health status Lower score = better health status
Baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Ankara City Hospital Bilkent

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

July 1, 2024

Primary Completion (Actual)

July 1, 2025

Study Completion (Actual)

July 1, 2025

Study Registration Dates

First Submitted

February 25, 2026

First Submitted That Met QC Criteria

February 25, 2026

First Posted (Actual)

March 2, 2026

Study Record Updates

Last Update Posted (Actual)

March 3, 2026

Last Update Submitted That Met QC Criteria

February 28, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • TABED 2-24-273

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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