Association of bone mineral density with perioperative hidden blood loss in older adults undergoing intramedullary nailing for unstable intertrochanteric fractures

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2026年6月10日

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Yan Qu,
Kairui Pan,
Shuo Wang,
Changwen Gu,
Ruru Wang,
Hua Wang

摘要

Background

The influence of bone mineral density (BMD) on hidden blood loss (HBL) in older patients with unstable intertrochanteric fractures treated with intramedullary nailing (IMN) is underexplored. The current retrospective cohort study aimed to evaluate the relationship between BMD and perioperative HBL in these cases.

Materials and methods

A total of 115 patients aged > 60 years undergoing IMN between January 2022 and December 2024 were included. Data included demographics, BMD T score, preoperative hemoglobin (Hb), medical history, and HBL(calculated using the Nadler formula). Spearman correlation, Mann-Whitney U tests, and multiple linear regression were applied to identify factors associated with HBL.

Results

Patients (mean age 82.90 ± 9.48 years, 29.57% male) had a mean BMD T-score of -3.29 ± 2.17. Lower BMD T-score (β = -14.35, p < 0.001) and lower preoperative Hb (β = -1.282, p = 0.033) were independently associated with greater HBL on postoperative day 3; a history of hypertension was independently associated with lower HBL after adjustment (β = -24.56, p = 0.016). Similar associations were observed on postoperative day 7 (BMD T-score: β = -17.14, p < 0.001; hypertension: β = -23.22, p = 0.045). Other factors showed no significant association.

Conclusion

In this retrospective cohort study of older adults undergoing intramedullary nailing for unstable intertrochanteric fractures, lower BMD T-score and lower preoperative Hb were independently associated with greater perioperative HBL, while a history of hypertension appeared to be independently associated with lower HBL after adjustment. These associations were moderate in magnitude and should be interpreted with caution given the retrospective design, imbalanced BMD subgroups, and missing postoperative day-7 data. Preoperative BMD assessment and Hb optimization may inform perioperative risk stratification, though prospective validation is required.