Assessing P1NP/β‐CTX as Potential Risk Factors Associated With Different Subtypes of Fragile Hip Fracture in Elderly Patients

ABSTRACT Objective Identifying the risk factor for occurrence of trochanteric/femoral neck fractures has always been difficult and crucial for prognosis of the diseases. The goal of this study is to evaluate the difference of P1NP/β‐CTX between trochanteric and femoral neck fractures and establish these two BTMs as independent risk factors for these two subtypes of hip fractures in the elderly. Methods Following case–control study design, 83 elderly patients with fragile hip fractures from two tertiary hospitals recruited between February 2023 to August 2024 were assigned into intertrochanteric fracture group (42 cases) and femoral neck fracture group (41 cases). Baseline characteristics including age, sex, height, weight, BMI, and history of diabetes/Parkinson's disease were collected after admission. Besides, P1NP/β‐CTX/PTH/25(OH)D blood tests and dual energy x‐ray absorptiometry (DXA) were performed on all participants before surgical operation. The statistical significances of categorical variables and continuous variables were established through χ 2‐tests and independent samples t‐tests, respectively. Multivariable logistic regression analysis was applied to detect potential associations between the selected variables and hip fracture subtype. Results The difference in P1NP between the trochanteric fracture group and femoral neck fracture groups is statistically significant. Specifically, patients with trochanteric fractures showed a markedly higher value of P1NP than those with femoral neck fractures (p = 0.044). However, no significant difference was observed for β‐CTX between the two groups (p = 0.941). Furthermore, BMDs at trochanter and total hip regions in the trochanteric fracture group were significantly lower than those in the femoral neck fracture group (p = 0.028; p = 0.022). After multifactorial logistic regression, P1NP, weight, and female were stronger risk factors for trochanteric fracture (OR 0.969, 95% CI 0.948–0.990, p = 0.004; OR 0.531, 95% CI 0.284–0.992, p = 0.047; OR 0.082, 95% CI 0.008–0.837, p = 0.035), while height was found to be independently associated with femoral neck fracture (OR 1.715, 95% CI 1.023–2.874, p = 0.041). Conclusions Compared with femoral neck fractures, P1NP was established as an independent risk factor for trochanteric fractures, suggesting the great potential of this BTM as a predictive indicator and postoperative complication monitor for trochanteric fractures.