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

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.