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What is the importance of canal-to-diaphysis ratio on osteoporosis-related hip fractures?

Bozkurt HH1Tokgöz MAYapar AAtik OŞ.

Eklem Hastalik Cerrahisi. 2019 Dec;30(3):296-300. doi: 10.5606/ehc.2019.70745.




This study aims to investigate whether the ratio of the canal-to-diaphysis in femoral subtrochanteric region is helpful in determining risk before hip fracture.


The study group consisted of 116 patients with osteoporotic hip fractures (26 males, 90 females; mean age 77.8 years; range, 61 to 89 years) and the control group consisted of 56 subjects (11 males, 45 females; mean age 75.3 years; range, 60 to 83 years). The canal-to-diaphysis ratio of patients in the study group was measured on plain radiographs. The results of the affected side and intact side were compared. To ensure the interobserver reliability of the measurements and to minimize technical errors, the assessments were performed twice (two weeks apart) by two different orthopedic surgeons.


The canal-to-diaphysis ratio was significantly increased in patients with hip fracture compared with the intact side of same patient (p<0.001) and control subjects (p<0.001). According to the results of the receiver operating characteristic analysis, canal-to-diaphysis ratio had a diagnostic value in predicting hip fracture in osteoporosis patients, and the limit value was approximately 0.53 (sensitivity: 81%, specificity: 86%). An index of 0.53 represents a risk of intertrochanteric hip fracture of 89%.


This method can be easily applied by all physicians as X-ray device is readily accessible with low cost. The risk of hip fracture should be determined, osteoporosis should be evaluated, and treatment should be started in patients with high risk to take the necessary precautions before the fracture develops.