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: 4.94). 02/2003; 2(1):57-93. DOI: 10.1016/S1568-1637(02)00045-4
Source: PubMed


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.


Available from: Ray Marks, Sep 12, 2014
  • Source
    • "Incidence of falls escalates with age, events exacerbated by declines in muscle mass, strength, coordination and balance [1], [2]. When considered in concert with age-related decline in bone quality and quantity [3], this elevated risk of falling portends an increase in the incidence of injury, including fracture [4]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Poor balance in older persons contributes to a rise in fall risk and serious injury, yet no consensus has developed on which measures of postural sway can identify those at greatest risk of falling. Postural sway was measured in 161 elderly individuals (81.8y±7.4), 24 of which had at least one self-reported fall in the prior six months, and compared to sway measured in 37 young adults (34.9y±7.1). Center of pressure (COP) was measured during 4 minutes of quiet stance with eyes opened. In the elderly with fall history, all measures but one were worse than those taken from young adults (e.g., maximal COP velocity was 2.7× greater in fallers than young adults; p<0.05), while three measures of balance were significantly worse in fallers as compared to older persons with no recent fall history (COP Displacement, Short Term Diffusion Coefficient, and Critical Displacement). Variance of elderly subjects' COP measures from the young adult cohort were weighted to establish a balance score ("B-score") algorithm designed to distinguish subjects with a fall history from those more sure on their feet. Relative to a young adult B-score of zero, elderly "non-fallers" had a B-score of 0.334, compared to 0.645 for those with a fall history (p<0.001). A weighted amalgam of postural sway elements may identify individuals at greatest risk of falling, allowing interventions to target those with greatest need of attention.
    PLoS ONE 08/2013; 8(8):e70566. DOI:10.1371/journal.pone.0070566 · 3.23 Impact Factor
  • Source
    • "Therefore, we investigated the fracture load at the femoral neck in a direction parallel to the femoral shaft axis; however, the axial loading may influence the fracture types owing to different internal stress distributions. Although approximately half of osteoporotic hip fractures are intertrochanteric in human [28], all fractures in the present study were found in midcervical region. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hip fracture is associated with pronounced morbidity and excess mortality in elderly women with postmenopausal osteoporosis. Many drugs have been developed to treat osteoporosis and to reduce the risk of osteoporotic fractures. We investigated the effects of combined alendronate and vitamin D3 treatment on bone mass and fracture load at the femoral neck in ovariectomized (OVX) rats, and evaluated the relationship between bone mass parameters and femoral neck strength. Thirty 12-week-old female rats underwent either a sham-operation (n = 6) or OVX (n = 24). Twenty weeks later, OVX rats were further divided into four groups and received daily doses of either saline alone, 0.1 mg/kg alendronate, 0.1 microg/kg calcitriol, or a combination of both two drugs by continuous infusion via Alzet mini-osmotic pumps. The sham-control group received saline alone. After 12 weeks of treatment, femoral necks were examined using peripheral quantitative computed tomography (pQCT) densitometry and mechanical testing. Saline-treated OVX rats showed significant decreases in total bone mineral content (BMC) (by 28.1%), total bone mineral density (BMD) (by 9.5%), cortical BMC (by 26.3%), cancellous BMC (by 66.3%), cancellous BMD (by 29.0%) and total cross-sectional bone area (by 30.4%) compared with the sham-control group. The combined alendronate and calcitriol treatments improved bone loss owing to estrogen deficiency. On mechanical testing, although OVX significantly reduced bone strength of the femoral neck (by 29.3%) compared with the sham-control group, only the combined treatment significantly improved the fracture load at the femoral neck in OVX rats to the level of the sham-controls. The correlation of total BMC to fracture load was significant, but that of total BMD was not. Our results showed that the combined treatment with alendronate and calcitriol significantly improved bone fragility of the femoral neck in OVX osteopenic rats.
    Journal of Orthopaedic Surgery and Research 01/2009; 3(1):51. DOI:10.1186/1749-799X-3-51 · 1.39 Impact Factor
  • Source
    • "Besides, a carpet is able to reduce the traumatic forces that result from falling, which reduces the effect of falling on the limb. In contrast to Iran, in western countries, floors are made of wood and tiles [12–14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to estimate the incidence of hip fracture in Zanjan, Iran and to describe its seasonal variation. A total of 244 cases of hip fractures (131 men, 113 women) were recorded during 1 year. The annual age-standardized incidence rates were 206.5 and 214.8 per 100,000 men and women, respectively. Most fractures occurred in winter, in-house and daytime. In-hospital mortality was 2.5%. Incidence rate of hip fracture (HF) was less than in western countries mostly due to lower incidence in women, which is probably because of breast-feeding. Introduction One of the most important consequences of osteoporosis is HF, which causes high mortality, morbidity, and significant costs. The incidence of HF in the elderly varies in different areas. Various incidence rates of HF have been reported from countries in the Middle East. The aim of this prospective study was to estimate the annual incidence of hip fracture in Zanjan, a province of Iran, and to describe the seasonal variation of HF incidence which has not been evaluated in two previous studies conducted in this country. Materials and methods All cases of HF aged 50 years or more admitted in three referral hospitals with orthopedics facilities in Zanjan province between 21 March 2006 and 20 March 2007 were subjected in the study. The age- and sex-specific incidence rates of hip fracture per 100,000 person-years were calculated using the population data from the last national census in Iran 2007. Results A total of 244 cases of hip fractures (131 men, 113 women) were recorded. The annual age-standardized incidence rate was 214.8 per 100,000 women and 206.5 per 100,000 men. The number (%) of fall-induced HF was 88 (67.2%) in men and 102 (90.3%) in women. The female to male ratio for total and fall-related HF was 1.0 and 1.1, respectively. The HF was more predominant in winter (38.5%). In-hospital mortality was 2.5%, and majority of HF were sustained in-house and daytime. Conclusion We found a relatively low incidence of hip fracture and fall-related hip fracture in Iran than those in western countries, which is mostly due to the lower rate in women. These findings disagree with our expectations considering the bone mineral density and vitamin D status of Iranian population, especially women. Breastfeeding could be one of the probable protective factors.
    Archives of Osteoporosis 12/2008; 3(1):1-5. DOI:10.1007/s11657-008-0016-2
Show more