Statistical shape modeling of the proximal femur in Mexican women: a cross-sectional morphometric and densitometric study

This study applied statistical shape modeling to 284 DXA hip scans from Mexican women, identifying proximal femur morphotypes characterized by long, narrow necks and valgus orientation. These shape patterns showed directionally lower regional BMD in vulnerable areas, although associations were modest. The findings describe femoral configurations that resemble those previously associated with fracture risk in international cohorts, supporting the potential role of morphometric analysis as a complementary, population-specific approach to skeletal fragility assessment. PURPOSE: Hip fractures are a major cause of disability and mortality in older adults, particularly among women with osteoporosis. Bone mineral density (BMD) is a cornerstone of fracture risk assessment but does not fully capture biomechanical and structural vulnerability. This study is aimed at characterizing proximal femur morphology in Mexican women using statistical shape modeling and at examining its relationship with regional BMD. METHODS: In this exploratory cross-sectional analysis, 284 dual-energy X-ray absorptiometry (DXA) hip scans were processed with BoneFinder software to generate morphometric profiles. Active Shape Models (ASM) identified the main modes of shape variation, which were analyzed in relation to site-specific BMD. RESULTS: Seventeen femoral configurations were identified, with three representative morphotypes: long, narrow necks with valgus alignment, short and wide necks, and intermediate morphologies. Shape patterns characterized by long, narrow, valgus-oriented femoral necks showed directionally lower regional BMD in the superior neck and Ward's triangle-sites critical for fracture initiation-although associations were modest in regression analyses. Automated morphometry identified structural traits linked to mechanical disadvantage beyond traditional cortical indices. CONCLUSION: This is the first study to apply statistical shape modeling to Latin American women, identifying recurring femoral shape patterns that resemble morphologies previously associated with fracture risk in international cohorts. While prospective validation with fracture outcomes is needed, this exploratory study provides foundational evidence for anatomically informed, population-specific approaches to skeletal fragility assessment.