Femoral arterial calcification severity on admission pelvic radiographs and 90-day mortality after hip fracture

Fırat Doğruöz; Safa Arıkan; Kaan Sarıtaş; Serkan Gürcan; Özkan Köse

Femoral arterial calcification severity on admission pelvic radiographs and 90-day mortality after hip fracture

Abstract

Aims: To determine whether the severity of femoral arterial calcification (FAC) visible on routine admission pelvic radiographs is associated with 90-day all-cause mortality after surgically treated hip fracture. Methods: This retrospective single-center cohort study included 371 patients aged 60 years or older who underwent surgery for a femoral neck or intertrochanteric fracture between September 12, 2021, and March 29, 2026. FAC was classified on admission radiographs as grade 0 (absent), grade I (mild), grade II (moderate), or grade III (severe). The primary outcome was all-cause mortality within 90 days of hospital admission. A single multivariable logistic regression model included age, gender, Charlson Comorbidity Index (CCI), fracture type, time from admission to surgery, and FAC grade. Kaplan-Meier curves were compared using the log-rank test. Results: The mean age was 80.8±8.2 years, and 219 patients (59.0%) were female. FAC was grade 0 in 48 patients (12.9%), grade I in 92 (24.8%), grade II in 107 (28.8%), and grade III in 124 (33.4%). Thirty-day and 90-day mortality occurred in 44 (11.9%) and 85 (22.9%) patients, respectively. Ninety-day mortality did not differ among FAC grades (20.8%, 23.9%, 25.2%, and 21.0%, respectively; p=0.859). In the multivariable model, older age (adjusted odds ratio [OR] 1.06 per year, 95% confidence interval [CI] 1.02-1.10; p=0.002) and higher CCI (adjusted OR 1.18 per point, 95% CI 1.03-1.36; p=0.018) were associated with increased mortality, whereas female gender was associated with lower mortality (adjusted OR 0.54, 95% CI 0.32-0.92; p=0.022). FAC grade was not independently associated with mortality (adjusted OR 0.87 per grade, 95% CI 0.67-1.11; p=0.264). Kaplan-Meier survival curves did not differ among grades (log-rank p=0.843). Conclusion: In this single-center cohort, increasing radiographic FAC severity was not associated with higher 90-day mortality and did not show a clear dose-response pattern. Established clinical factors, particularly age, gender, and comorbidity burden, were more informative predictors of early mortality than FAC grade. External validation of the proposed FAC grading system is required before broader conclusions regarding its prognostic utility can be drawn.

Keywords

Supporting Institution

No external funding was received for this study.

Ethical Statement

This study was approved by the Antalya Training and Research Hospital Scientific Research Ethics Committee (Decision No. 10/17; Study No. 2026-282; May 21, 2026). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The requirement for written informed consent was waived by the Ethics Committee because of the retrospective study design and the use of anonymized clinical and radiographic data.

Thanks

None

References

Feng JN, Zhang CG, Li BH, Zhan SY, Wang SF, Song CL. Global burden of hip fracture: the global burden of disease study. Osteoporos Int. 2024; 35(1):41-52. doi:10.1007/s00198-023-06907-3
Sing CW, Lin TC, Bartholomew S, et al. Global epidemiology of hip fractures: secular trends in incidence rate, post-fracture treatment, and all-cause mortality. J Bone Miner Res. 2023;38(8):1064-1075. doi:10.1002/jbmr.4821
Bui M, Nijmeijer WS, Hegeman JH, Witteveen A, Groothuis-Oudshoorn CGM. Systematic review and meta-analysis of preoperative predictors for early mortality following hip fracture surgery. Osteoporos Int. 2024;35(4):561-574. doi:10.1007/s00198-023-06942-0
Bourne LE, Wheeler-Jones CP, Orriss IR. Regulation of mineralisation in bone and vascular tissue: a comparative review. J Endocrinol. 2021; 248(2):R51-R65. doi:10.1530/JOE-20-0428
Gebre AK, Lewis JR, Leow K, et al. Abdominal aortic calcification, bone mineral density, and fractures: a systematic review and meta-analysis of observational studies. J Gerontol A Biol Sci Med Sci. 2023;78(7):1147-1154. doi:10.1093/gerona/glac171
Tanna N, Patel K, Moore AE, Dulnoan D, Edwards S, Hampson G. The relationship between circulating adiponectin, leptin and vaspin with bone mineral density (BMD), arterial calcification and stiffness: a cross-sectional study in post-menopausal women. J Endocrinol Invest. 2017; 40(12):1345-1353. doi:10.1007/s40618-017-0711-1
Kim KJ, Kim KM, Park KH, et al. Aortic calcification and bone metabolism: the relationship between aortic calcification, BMD, vertebral fracture, 25-hydroxyvitamin D, and osteocalcin. Calcif Tissue Int. 2012;91(6):370-378. doi:10.1007/s00223-012-9642-1
Arzu U, Özmusul VB, Gündoğdu M, Koncalıoğlu B, Gencer B, Gülabi D. Prognostic significance of radiographically detected arterial calcification in geriatric hip fracture patients: abdominal aortic calcification as an independent predictor of mortality. Ulus Travma Acil Cerrahi Derg. 2026;32(2):190-196. doi:10.14744/tjtes.2026.46072

Hsu SN, Ding JJ, Tsai PH, Yang CL, Hsu CL, Hsu YJ. Femoral artery calcification predicts hip fracture in maintenance hemodialysis patients. Arch Osteoporos. 2025;20(1):112. doi:10.1007/s11657-025-01536-1
Bayram S, Yıldırım AM, Birişik F, Salduz A. Radiological parameter associated with the survival of old patients with hip fracture. Injury. 2021;52(11):3388-3396. doi:10.1016/j.injury.2021.07.027
Yolaçan H, Güler S. Does femoral arterial calcification have an effect on mortality in patients who underwent hemiarthroplasty due to hip fracture? Cureus. 2023;15(10):e46437. doi:10.7759/cureus.46437
Birişik F, Bilgin Y, Bayram S, Öztürkmen Y. Does presence of femoral arterial calcification have an effect on postoperative complication and mortality in patients with hip fracture? Cureus. 2021;13(5):e14878. doi:10.7759/cureus.14878
Pazarcı Ö, Ekici C, Yazıcı K, Kılınç S, Öztürk H. Is femoral artery calcification a sign of mortality in elderly hip fractures? Anatomy. 2019; 13(2):98-101. doi:10.2399/ana.19.051
Wilson CB. An updated Declaration of Helsinki will provide more protection. Nat Med. 2013;19(6):664. doi:10.1038/nm0613-664
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383. doi:10.1016/0021-9681(87)90171-8
Hendrix JM, Garmon EH. American Society of Anesthesiologists Physical Status Classification System. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026.
Altınayak M, Karatekin G. Is the presence of vascular calcification in hip X-rays a predictor of postoperative mortality in intertrochanteric fracture of the femur? Acta Orthop Traumatol Turc. 2024;58(4):235-240. doi:10.5152/j.aott.2024.23195

Details

Primary Language

English

Subjects

Orthopaedics

Journal Section

Research Article

Authors

Fırat Doğruöz ^*
0000-0003-0819-3196
Türkiye

Safa Arıkan This is me
0009-0006-8171-9392
Türkiye

Kaan Sarıtaş
0000-0002-6432-363X
Türkiye

Serkan Gürcan This is me
0000-0001-7768-1826
Türkiye

Özkan Köse
0000-0002-7679-9635
Türkiye

Publication Date

October 25, 2026

Submission Date

August 5, 2026

Acceptance Date

September 4, 2026

Published in Issue

Year 2026 Volume: 7 Number: 5

IZ

https://izlik.org/JA62TR84UU

Cite

RIS / Bibtex

APA

Doğruöz, F., Arıkan, S., Sarıtaş, K., Gürcan, S., & Köse, Ö. (2026). Femoral arterial calcification severity on admission pelvic radiographs and 90-day mortality after hip fracture. Journal of Medicine and Palliative Care, 7(5), 993-1000. https://izlik.org/JA62TR84UU

AMA

1.Doğruöz F, Arıkan S, Sarıtaş K, Gürcan S, Köse Ö. Femoral arterial calcification severity on admission pelvic radiographs and 90-day mortality after hip fracture. J Med Palliat Care / JOMPAC / jompac. 2026;7(5):993-1000. https://izlik.org/JA62TR84UU

Chicago

Doğruöz, Fırat, Safa Arıkan, Kaan Sarıtaş, Serkan Gürcan, and Özkan Köse. 2026. “Femoral Arterial Calcification Severity on Admission Pelvic Radiographs and 90-Day Mortality After Hip Fracture”. Journal of Medicine and Palliative Care 7 (5): 993-1000. https://izlik.org/JA62TR84UU.

EndNote

Doğruöz F, Arıkan S, Sarıtaş K, Gürcan S, Köse Ö (October 1, 2026) Femoral arterial calcification severity on admission pelvic radiographs and 90-day mortality after hip fracture. Journal of Medicine and Palliative Care 7 5 993–1000.

IEEE

[1]F. Doğruöz, S. Arıkan, K. Sarıtaş, S. Gürcan, and Ö. Köse, “Femoral arterial calcification severity on admission pelvic radiographs and 90-day mortality after hip fracture”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 5, pp. 993–1000, Oct. 2026, [Online]. Available: https://izlik.org/JA62TR84UU

ISNAD

Doğruöz, Fırat - Arıkan, Safa - Sarıtaş, Kaan - Gürcan, Serkan - Köse, Özkan. “Femoral Arterial Calcification Severity on Admission Pelvic Radiographs and 90-Day Mortality After Hip Fracture”. Journal of Medicine and Palliative Care 7/5 (October 1, 2026): 993-1000. https://izlik.org/JA62TR84UU.

JAMA

1.Doğruöz F, Arıkan S, Sarıtaş K, Gürcan S, Köse Ö. Femoral arterial calcification severity on admission pelvic radiographs and 90-day mortality after hip fracture. J Med Palliat Care / JOMPAC / jompac. 2026;7:993–1000.

MLA

Doğruöz, Fırat, et al. “Femoral Arterial Calcification Severity on Admission Pelvic Radiographs and 90-Day Mortality After Hip Fracture”. Journal of Medicine and Palliative Care, vol. 7, no. 5, Oct. 2026, pp. 993-1000, https://izlik.org/JA62TR84UU.

Vancouver

1.Fırat Doğruöz, Safa Arıkan, Kaan Sarıtaş, Serkan Gürcan, Özkan Köse. Femoral arterial calcification severity on admission pelvic radiographs and 90-day mortality after hip fracture. J Med Palliat Care / JOMPAC / jompac [Internet]. 2026 Oct. 1;7(5):993-1000. Available from: https://izlik.org/JA62TR84UU