Hip fractures among the elderly: Causes, consequences and control

Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Ageing Research Reviews (Impact Factor: 7.63). 02/2003; 2(1):57-93. DOI: 10.1016/S1568-1637(02)00045-4
Source: PubMed

ABSTRACT This review examines all pertinent literature sources published in the English language between 1966 to the present concerning hip fracture epidemiology, hip fracture injury mechanisms, and hip fracture management strategies. These data reveal hip fractures have several causes, but among these, the impact of falls and muscle weakness, along with low physical activity levels seems to be the most likely explanation for the rising incidence of hip fracture injuries. Related determinants of suboptimal nutrition, drugs that increase fall risk and lower the safety threshold and comorbid conditions of the neuromuscular system may also contribute to hip fracture disability. A number of interventions may help to prevent hip fracture injuries, including, interventions that optimize bone mass and quality, interventions that help prevent falls and falls dampening interventions. Rehabilitation outcomes may be improved by comprehensive interventions, prolonged follow-up strategies and ensuring that all aging adults enjoy optimal health.

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Available from: Ray Marks, Sep 12, 2014
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    • "The elderly population, defined as 65 years of age and older in Taiwan, will increase from 7.6% of the total population in 1995 to more than 15% in the next decade [16]. With an increasingly aging population, the occurrence of hip fractures will predictably rapidly increase and will represent a major and growing health care problem [17] [18]. Chie et al. used the inpatient database of the National Health Insurance Program to investigate the incidence rate of hip fracture in Taiwan from 1996 to 2000 and found a higher incidence than in other reports of ethnic Chinese populations, and similar to that of Western countries [19]. "
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    ABSTRACT: To investigate the recent longitudinal trend of hip fractures (including cervical and trochanteric fractures) in Taiwan's elderly population (> or =65 years), a nationwide descriptive epidemiological study was conducted using the database of the Bureau of National Health Insurance from 1996 through 2002. Frequencies and incidences of hip fracture by gender, fracture site, and age group were estimated, and the 7-year incidence trend was further evaluated. The results showed that a total of 75,482 hip fractures occurred during the study period with an incidence rate of 57.54 per 10,000 per year. Overall incidence significantly increased by 30% (p<0.0001), from 49.56 to 64.37 per 10,000 per year during the 7-year study period. The increase in rates was greater in males (36%) than in females (22%). The average female-to-male ratio was 1.76, lower than those in many countries. In females, the annual incidence of cervical fracture was higher than that of trochanteric fractures throughout the 7 years, while the incidence of trochanteric fractures was higher than cervical fractures each year in males (p<0.0001). The average annual incidence of patients older than 85 years was 9.9 times higher than that of aged 65 to 69 years in females and 7.9 times in males. Development and implementation of public health strategies for hip fractures should more focus on these subgroups in Taiwan's rapidly aging society.
    Bone 09/2008; 44(1):125-9. DOI:10.1016/j.bone.2008.09.004 · 4.46 Impact Factor
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    • "In older people, hip fractures are one of the most serious health care problems associated with substantial mortality, morbidity, and economic costs [1] [2] [3]. The incidence of hip fractures increases with age, and the total number of fractures is still expected to rise due to population aging [4]. "
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    ABSTRACT: In Central Finland, the age-specific incidence of hip fractures did not change between the years 1982-1983 and 1992-1993 though the total number of hip fractures increased by 11% due to population aging. The objective of this study was to define the current hip fracture rates and the characteristics of patients with hip fracture. The population at risk consisted of 240,000 persons living in the Central Finland Health Care District. Hip fracture patients were identified by using the hospital discharge register, the operation lists, and the register of the Department of Anesthesiology. Patients' residential status, weight, and height, date and time of hip fracture, place of accident and mechanism and type of fracture were obtained from medical records. A total of 597 patients, 415 (69.5%) women and 182 (30.5%) men, were admitted to the hospital for treatment of an acute hip fracture in 2002-2003. The mean age of the patients was 79 (SD 13) years. Among patients aged > or =50 years (n = 577), 80.8% of the hip fractures had occurred indoors, 97.6% with a low-energetic mechanism, and 22.7% during the nighttime. The ratio of trochanteric to cervical fractures was 2:3. Between 1992-1993 and 2002-2003, the total number of hip fractures increased by 70%, from 351 to 597. The fracture rates per 1000 person-years in the age group > or =55 years were 2.0 and 3.9 in 1992-1993 and 2.8 and 5.6 in 2002-2003 for men and women, respectively. The corresponding age-adjusted incidence rate ratio (IRR) for men was 1.36 (95% CI: 1.06 to 1.76), P = 0.017, and for women 1.25 (95% CI: 1.07 to 1.47), P = 0.006. Among men, the IRR was highest in the age group 75-84 years, IRR = 1.67 (95% CI: 1.08 to 2.65), while among women, it was highest in the age group > or =85 years, IRR = 1.33 (95% CI: 1.02 to 1.75). The total number of hip fractures almost doubled within 10 years, and the age-adjusted incidence rate increased in both sexes. The accretion of the hip fracture incidence was more than could be explained merely by changes in population size and structure.
    Bone 09/2006; 39(3):623-7. DOI:10.1016/j.bone.2006.03.001 · 4.46 Impact Factor
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    • "Effective preventive strategies require a better understanding of the characteristics of injurious falls leading to hip fractures among elderly persons. In addition, there may be different patterns for fall injuries in different communities [9]. For instance, persons residing in urban areas Bone 39 (2006) 408 – 413 of China have lower probability of falls and fall-induced hip fractures comparing to Western societies [10], which may point to some potential culture-specific protective factors against these events. "
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    ABSTRACT: An estimated one in three adults aged 65 years or older falls each year, making falls a major health concern. Hip fractures are the most serious consequences of falls in elderly people. Identifying the characteristics of falls leading to hip fracture may provide information about high risk individuals, environment, and activities useful for the development of intervention strategies. Little is known, however, about the incidence and characteristics of falls leading to hip fracture in Middle Eastern countries. Therefore, the authors presented data from the Iranian Multicenter Study on Accidental Injuries, a prospective population-based study conducted in 9 provinces of Iran in 2003. All the hospitals serving about 9.5 million people in the study area were prospectively surveyed for any incident injury resulting from accidental events. A total of 2,186 patients (1,372 male, 814 female) were admitted due to any injurious fall events, where 572 (26.2%) of them suffered a hip fracture. Annual incidence rates of injurious fall events and related hip fractures were 116.3 and 30.4 per 100,000 person-years, respectively. These figures were 237.1 and 93.6 per 100,000 person-years for people over the age of 50 years, respectively. 71% of fall injuries and 76% of hip fractures occurred indoors. Among 450 patients with hip fractures >or=50 years of age, 61.8% arose from a fall from standing height or less. Only 1 in these 450 hip fractures occurred at the time of recreational activity. In multivariate logistic regression analysis, no factor was an independent predictor of hip fractures comparing to other fall-related injuries among younger participants (>or=20 and <50 years). For older patients, falls from standing height or loss (odds ratio (OR) = 2.67), falls during walking (OR = 1.71), and falls on stairs (OR = 1.73) were detected as risk factors of hip fracture. Married persons and those falling from a ladder or other elevations were less likely to fracture their hip in this age group. Our data suggest that modification of the factors external to the homes is less likely to prevent more than a small proportion of fall-related hip fractures in Iran. Further studies on this topic have potential applications for developing preventive strategies.
    Bone 09/2006; 39(2):408-13. DOI:10.1016/j.bone.2006.01.144 · 4.46 Impact Factor
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