The morphometric parameters of femur proximal part and its relationship with body mass index

Document Type : Original Article


1 Anatomical Sciences Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran

2 Social Determinants of Health (SDH) Research Center, Kashan, Iran

3 Anatomical Sciences Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran Gametogenesis Sciences Research Center, Institute for Basic Sciences, Kashan University of Medical Science, Kashan, Iran

4 Gametogenesis Sciences Research Center, Institute for Basic Sciences, Kashan University of Medical Science, Kashan, Iran


Background: The femur is the longest bone in the body. Injury or fracture in this bone strongly affects the quality of life of people.
Objectives: The aim of this study was to investigate the morphometric parameters of femur proximal part and its relationship with body mass index (BMI).
Methods: This descriptive-analytical study was conducted on 200 patients over 50 years of age referred to Shahid Beheshti Hospital in Kashan and Ayatollah Kashani Hospital in Isfahan during 2018-2019. The participants had radiographs in the supine position of femur proximal part. BMI and bone mineral density of patients were determined by the DXA method. Using radiographic images of the femur, the morphological features were evaluated. Also, the relationship of these characteristics with age, gender, BMI and bone mineral density was investigated.
Results: The values of six morphological parameters of the femur in the patients under study were Q-angle=121.93±3.78, TW=86.06±7.65, HW=52.4±4.69, FW=37.74±4.29, HAL=118.43±10.47 and FAL=105.34±7.59 mm, which were higher in men. There was a direct and significant correlation of 23% between age and TW, which was significant according to the Pearson Correlation Test (P=0.039). Inverse correlation of 14% was observed between HAL width and BMI, which was statistically significant (P=0.042). FAL variable had a decreasing trend with decreasing BMD (P=0.031).
Conclusion: Proximal femur characteristics were significantly related to factors such as gender and BMI. The morphological specifications of femur proximal were higher in men than in women. Compared to evaluations in other regions, the included characteristics are distinct from other countries, which these differences can be caused by genetic characteristics, environment, nutritional status, and lifestyle.


Hossein Nikzad [Pubmed] [Google Scholar]



  1. Faulkner KG, Cummings SR, Black D, Palermo L, Glüer CC, Genant HK. Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. J Bone Miner Res. 1993;8:1211-17. doi:10.1002/jbmr.5650081008 PMid:8256658
  2. Boonen S, Koutri R, Dequeker J, Aerssens J, Lowet G, Nijs J, et al. Measurement of femoral geometry in type I and type II osteoporosis: differences in hip axis length consistent with heterogeneity in the pathogenesis of osteoporotic fractures. J Bone Miner Res. 1995;10:1908-12. doi:10.1002/jbmr.5650101210 PMid:8619371
  3. Gregory JS, Testi D, Stewart A, Undrill PE, Reid DM, Aspden RM. A method for assessment of the shape of the proximal femur and its relationship to osteoporotic hip fracture. Osteoporos Int. 2004;15:5-11. doi:10.1007/s00198-003-1451-y PMid:14605797
  4. Głodek J, Milewska K, Tobolska A, Grabarczyk Ł, Maksymowicz W, Bada I, et al. Feline hip joint anatomy in magnetic resonance images. Anat Histol Embryol. 2019;48:449-54. doi:10.1111/ahe.12466 PMid:31348547
  5. Carballido-Gamio J, Harnish R, Saeed I, Streeper T, Sigurdsson S, Amin S, et al. Structural patterns of the proximal femur in relation to age and hip fracture risk in women. Bone. 2013;57:290-99. doi:10.1016/j.bone.2013.08.017 PMid:23981658 PMCid:PMC3809121
  6. Ravn P, Cizza G, Bjarnason N, Thompson D, Daley M, Wasnich R, et al. Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. J Bone Miner Res. 1999;14:1622-27. doi:10.1359/jbmr.1999.14.9.1622 PMid:10469292
  7. Testi D, Cappello A, Chiari L, Viceconti M, Gnudi S. Comparison of logistic and Bayesian classifiers for evaluating the risk of femoral neck fracture in osteoporotic patients. Medical and Biological Engineering and Computing 2001;39:633-37. doi:10.1007/BF02345434 PMid:11804168
  8. Liu J-M, Zhao H-Y, Ning G, Zhao Y-J, Zhang L-Z, Sun L-H, et al. Relationship between body composition and bone mineral density in healthy young and premenopausal Chinese women. Osteoporos Int. 2004;15:238-42. doi:10.1007/s00198-003-1536-7 PMid:14727013
  9. Hawker G, Hawker G, Jamal S, Jamal S, Ridout R, Ridout R, et al. A clinical prediction rule to identify premenopausal women with low bone mass. Osteoporos Int. 2002;13:400-06. doi:10.1007/s001980200046 PMid:12086351
  10. Munasinghe RL, Botea V, Edelson GW. Association among age, height, weight, and body mass index with discordant regional bone mineral density. J Clin Densitom. 2002;5:369-73. doi:10.1385/JCD:5:4:369 PMid:12665637
  11. Wang D, Shi L, Griffith JF, Qin L, Yew DT, Riggs CM. Comprehensive surface‐based morphometry reveals the association of fracture risk and bone geometry. J Orthop Res. 2012;30:1277-84. doi:10.1002/jor.22062 PMid:22253193
  12. Glüer CC, Cummings SR, Pressman A, Li J, Glüer K, Faulkner KG, et al. Prediction of hip fractures from pelvic radiographs: the study of osteoporotic fractures. J Bone Miner Res. 1994;9:671-77. doi:10.1002/jbmr.5650090512 PMid:8053396
  13. Pande I, O" Neill T, Pritchard C, Scott D, Woolf A. Bone mineral density, hip axis length and risk of hip fracture in men: results from the Cornwall Hip Fracture Study. Osteoporos Int. 2000;11:866-70. doi:10.1007/s001980070046 PMid:11199191
  14. Calis HT, Eryavuz M, Calis M. Comparison of femoral geometry among cases with and without hip fractures. Yonsei Med J. 2004;45:901-07. doi:10.3349/ymj.2004.45.5.901 PMid:15515202
  15. Gnudi S, Ripamonti C, Lisi L, Fini M, Giardino R, Giavaresi G. Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women. Osteoporos Int. 2002;13:69-73. doi:10.1007/s198-002-8340-2 PMid:11878458
  16. Greendale GA, Young JT, Huang M-H, Bucur A, Wang Y, Seeman T. Hip axis length in mid-life Japanese and Caucasian US residents: no evidence for an ethnic difference. Osteoporos Int. 2003;14:320-25. doi:10.1007/s00198-002-1367-y PMid:12730747
  17. Gupta M, Devadas D, Sahni C, Nayak A, Tiwari PK, Mishra A. Morphometric analysis of the proximal femur with its clinical correlation in Eastern Uttar Pradesh Region. Cureus. 2022;14. doi:10.7759/cureus.28780
  18. Cheng X, Lowet G, Boonen S, Nicholson P, Brys P, Nijs J, et al. Assessment of the strength of proximal femur in vitro: relationship to femoral bone mineral density and femoral geometry. Bone. 1997;20:213-18. doi:10.1016/S8756-3282(96)00383-3 PMid:9071471
  19. Nayak L, Baisakh P, Panda SK, Chinara PK. Co-relation between hip axis length and femoral neck-shaft angle with body mass index of indian population: a radiological study. Int J Cur Res Rev. 2021;13:115. doi:10.31782/IJCRR.2021.13826
  20. Gnudi S, Ripamonti C, Gualtieri G, Malavolta N. Geometry of proximal femur in the prediction of hip fracture in osteoporotic women. Br J Radiol. 1999;72:729-33. doi:10.1259/bjr.72.860.10624337 PMid:10624337
  21. Alonso CG, Curiel MD, Carranza FH, Cano RP, Pérez AD. Femoral bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Osteoporos Int. 2000;11:714. doi:10.1007/s001980070071
  22. Karlsson KM, Sernbo I, Obrant KJ, Redlund-Johnell I, Johnell O. Femoral neck geometry and radiographic signs of osteoporosis as predictors of hip fracture. Bone. 1996;18:327-30. doi:10.1016/8756-3282(96)00004-X PMid:8726389
  23. Vasta S, Andrade R, Pereira R, Bastos R, Battaglia AG, Papalia R, et al. Bone morphology and morphometry of the lateral femoral condyle is a risk factor for ACL injury. Knee Surg Sports Traumatol Arthrosc. 2018;26:2817-25. doi:10.1007/s00167-017-4761-x PMid:29299611
  24. Dehghan M, Abdoli-tafti A, Shafiei Alavijeh S, Rahmati Dehkordi F, Salehi Reyhani SM. Association between proximal femoral geometry and incidence of proximal femoral fractures. Koomesh. 2019;21:67-72.
  25. De Sousa E, Fernandes RMP, Mathias MB, Rodrigues MR, Ambram AJ, Babinski MA. Morphometric study of the proximal femur extremity in Brazilians. Int J Morphol. 2010;28:835-40. doi:10.4067/S0717-95022010000300027
  26. Bhattacharya S, Chakraborty PB, Mukherjee A. Study of proximal femoral morphometry by radiography and its correlation with body mass index. J Anat Soc India. 2012;61:183-88. doi:10.1016/S0003-2778(12)80029-3
  27. Irdesel J, Ari I. The proximal femoral morphometry of Turkish women on radiographs. European J Anat. 2006;10:21-26.
  28. Soltani A, Moayyeri A, Saadipoor A, Seyedahmadinejad S, Zandieh A, Ahmadi Abhari S. Determination of geometric indices of the femoral bone density and its association with bone density of proximal femur. Iran J Endoc Metab. 2009;10:557-62.
  29. Agostini GM, Ross AH. The effect of weight on the femur: a cross‐sectional analysis. J Forensic Sci. 2011;56:339-43. doi:10.1111/j.1556-4029.2010.01648.x PMid:21210806
  30. Beck TJ, Petit MA, Wu G, LeBoff MS, Cauley JA, Chen Z. Does obesity really make the femur stronger? BMD, geometry, and fracture incidence in the women's health initiative‐observational study. J Bone Miner Res. 2009;24:1369-79. doi:10.1359/jbmr.090307 PMid:19292617 PMCid:PMC2718796
  31. Barrera G, Bunout D, Gattás V, de la Maza MP, Leiva L, Hirsch S. A high body mass index protects against femoral neck osteoporosis in healthy elderly subjects. Nutrition. 2004;20:769-71. doi:10.1016/j.nut.2004.05.014 PMid:15325685
  32. Malekzadeh Shafaroudi M, Mohammadnegad B, Usefi G, Rezaei N. Study of relation between Neck Shaft Angle (NSA) and mineral density of the femoral head among old post menopausal women in east part of mazandaran province. Iran South Med J. 2016; 19: 586-97. doi:10.18869/acadpub.ismj.19.4.586
  33. Gnudi S, Sitta E, Pignotti E. Prediction of incident hip fracture by femoral neck bone mineral density and neck-shaft angle: a 5-year longitudinal study in post-menopausal females. Br J Radiol. 2012;85:e467-e73. doi:10.1259/bjr/57130600 PMid:22096224 PMCid:PMC3587077
  34. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. The Lancet. 2002;359:1761-67. doi:10.1016/S0140-6736(02)08657-9 PMid:12049882