Purpose: The purpose of this study was to quantify the modifications occurring in osteoporosis at the level of the human proximal femur throughout the trabecular structure, along with the identification of certain anatomic regions preferentially affected by osteoporosis. Another goal was to map the evolution of the radiodensity of the trabecular bone as osteoporosis progresses to an advanced stage. Methods: The study included CT scans (right femur) from 51 patients, out of which 40 had various degrees of osteoporosis, but no other local pathology. Ten regions of interest in two orthogonal slices have been identified and the differences in radiodensity as well as their evolution have been statistically analyzed in terms of relative and absolute changes. Results: A detailed spatial map showing the evolution of osteoporosis was obtained. As osteoporosis evolved, the relative decrease in radiodensity was inversely correlated to the radiodensity of the healthy bone. In particular, the region covering the Ward triangle decreased the most, by an average 61– 62% in osteopenia and 101– 106% in advanced osteoporosis, while the principal compressive group was affected the least, showing a decrease by an average 14– 15% in osteopenia and 29– 32% in advanced osteoporosis. The absolute decrease in radiodensity was not correlated to the radiodensity of the healthy bone and was shifted to the inferior-posterior edge of the femur. Inside the femoral head, the upper region was affected the most in absolute terms, while the greater trochanter was less affected than the femoral neck. The maximum metaphyseal cortical bone density was unaffected by the progression of osteoporosis. Conclusion: Significant differences were noticed in terms of the absolute and relative osteoporotic changes in radiodensity related to different anatomical regions of the human femoral bone. These differences become more pronounced as the disease progresses.

Background and Objectives: Body mass index (BMI) has a complex relationship with skeletal health. Higher BMI is often associated with higher bone mineral density (BMD), but this apparent densitometric advantage may not fully reflect bone microarchitecture. Trabecular bone score (TBS) may provide complementary information in overweight and obese postmenopausal women. This study evaluated the associations between BMI, BMD, and TBS in postmenopausal women and assessed whether increased BMI is associated with discordant skeletal phenotypes characterized by non-osteoporotic densitometric status but impaired trabecular microarchitecture. Materials and Methods: This retrospective observational study screened 110 DXA/TBS reports from patients evaluated in a tertiary DXA center. Inclusion criteria were female sex, postmenopausal status, available BMI or sufficient anthropometric data for BMI calculation, valid lumbar spine DXA, at least one valid hip DXA assessment, and valid lumbar TBS assessment. Four cases were excluded: two male patients and two non-menopausal female patients. The final analytical cohort included 106 postmenopausal women. Lumbar spine and hip BMD, T-scores, TBS, Bone Resilience Index, anthropometric variables, and menopausal variables were extracted from DXA/TBS reports. BMI was analyzed both continuously and by category: under/normal-weight, overweight, and obesity. Correlation analyses, group comparisons, and linear regression models were used to evaluate the relationship between BMI and skeletal parameters. Discordant skeletal phenotypes were defined descriptively as non-osteoporotic DXA findings combined with degraded TBS. Results: The final cohort had a mean age of 65.2 ± 7.6 years and a mean BMI of 27.3 ± 4.5 kg/m². BMI was positively associated with lumbar spine BMD (r = 0.392, p < 0.001), minimum femoral neck BMD (r = 0.382, p < 0.001), and minimum total hip BMD (r = 0.508, p < 0.001), but negatively associated with TBS (r = −0.307, p = 0.001). Mean TBS decreased across BMI categories, from 1.283 ± 0.084 in the under/normal-weight group to 1.255 ± 0.088 in the overweight group and 1.199 ± 0.109 in the obesity group. In the fully adjusted regression model including BMI, age, years since menopause, lumbar spine BMD, and lowest hip T-score, BMI remained an independent negative predictor of TBS (β = −0.0126, p < 0.001). Discordant skeletal phenotypes combining non-osteoporotic DXA status with degraded TBS were more frequent in patients with obesity. Conclusions: In postmenopausal women, higher BMI was associated with higher BMD but lower TBS, supporting a divergent relationship between densitometric findings and DXA-derived trabecular texture parameters. These findings suggest that TBS may complement BMD in describing skeletal imaging status in overweight and obese women. Because fracture outcomes and complete clinical risk data were not available, the present results should be interpreted as evidence of imaging discordance rather than direct evidence of clinical underdiagnosis or misclassification.

Background and Clinical Significance: Vascular complications occurring in the context of trans-trochanteric fractures are rare (mean incidence 0.2–0.5%) but can be fatal if not recognized and treated promptly. Most of the previously reported vascular injuries are iatrogenic, and various mechanisms of injury and producing agents have been reported. Case Presentation: We present a rare but severe vascular complication following proximal femur fracture fixation in the case of a 77-year-old patient, specifically, a deep femoral artery injury after DHS osteosynthesis. CT angiography identified the lesion in the territory of the profunda femoris artery, precisely at the level of the most distal screw, suggesting over-drilling as the underlying cause. The case is presented in the context of a literature review, updating the most important features of the vascular complications, incidence, diagnosis and treatment. Conclusions: This case highlights the critical role of early diagnosis and prompt interdisciplinary collaboration between orthopedic and vascular surgeons in managing iatrogenic vascular complications, achieving a favorable outcome.