ObjectiveTo explore the predictive effect of the femoral neck strength composite indexes on femoral head collapse in non-traumatic osteonecrosis of the femoral head (ONFH) compared with bone turnover marker.MethodsThe non-traumatic ONFH patients who were admitted and received non-surgical treatment between January 2010 and December 2016 as the research object. And 96 cases (139 hips) met the selection criteria and were included in the study. There were 54 males (79 hips) and 42 females (60 hips), with an average age of 40.2 years (range, 22-60 years). According to whether the femoral head collapsed during follow-up, the patients were divided into collapsed group and non-collapsed group. The femoral neck width, hip axis length, height, body weight, and bone mineral density of femoral neck were measured. The femoral neck strength composite indexes, including the compressive strength index (CSI), bending strength index (BSI), and impact strength index (ISI), were calculated. The bone turnover marker, including the total typeⅠcollagen amino terminal elongation peptide (t-P1NP), β-crosslaps (β-CTx), alkaline phosphatase (ALP), 25 hydroxyvitamin D [25(OH)D], and N-terminal osteocalcin (N-MID), were measured. The age, gender, height, body weight, body mass index (BMI), bone mineral density of femoral neck, etiology, Japanese Osteonecrosis Investigation Committee (JIC) classification, femoral neck strength composite indexes, and bone turnover marker were compared between the two groups, and the influencing factors of the occurrence of femoral head collapse were initially screened. Then the significant variables in the femoral neck strength composite indexes and bone turnover marker were used for logistic regression analysis to screen risk factors; and the receiver operating characteristic (ROC) curve was used to determine the significant variables’ impact on non-traumatic ONFH. ResultsAll patients were followed up 3.2 years on average (range, 2-4 years). During follow-up, 46 cases (64 hips) had femoral head collapse (collapsed group), and the remaining 50 cases (75 hips) did not experience femoral head collapse (non-collapsed group). Univariate analysis showed that the difference in JIC classification between the two groups was significant (Z=–7.090, P=0.000); however, the differences in age, gender, height, body weight, BMI, bone mineral density of femoral neck, and etiology were not significant (P>0.05). In the femoral neck strength composite indexes, the CSI, BSI, and ISI of the collapsed group were significantly lower than those of the non-collapsed group (P<0.05); in the bone turnover marker, the t-P1NP and β-CTx of the collapsed group were significantly lower than those of the non-collapsed group (P<0.05); there was no significant difference in N-MID, 25(OH)D or ALP between groups (P>0.05). Multivariate analysis showed that the CSI, ISI, and t-P1NP were risk factors for femoral collapse in patients with non-traumatic ONFH (P<0.05). ROC curve analysis showed that the cut-off points of CSI, BSI, ISI, t-P1NP, and β-CTx were 6.172, 2.435, 0.465, 57.193, and 0.503, respectively, and the area under the ROC curve (AUC) were 0.753, 0.642, 0.903, 0.626, and 0.599, respectively. ConclusionThe femoral neck strength composite indexes can predict the femoral head collapse in non-traumatic ONFH better than the bone turnover marker. ISI of 0.465 is a potential cut-off point below which future collapse of early non-traumatic ONFH can be predicted.