Posted: April 4th, 2015

Hip Fractures

FOCUS ON
(1) how the studies were designed,
(2) the number of subjects in each study,
(3) the treatments provided to the subjects in each of the study groups , and
(4) the results of the studies.

Abstract
Each year, there are millions of elderly adults around the age of 65 and older that fall. Falls can cause serious injuries like hip fractures. As our population continues to age, hip fractures are steadily increasing. Hip fractures among our older adults can often cause long-term functional impairment and 1 out of 5 deaths occur within less than a year due to issues associated with them. More women than men sustain hip fractures and white women are more likely than African-American or Asian women to have increase in hip fractures. These hip fractures among the elderly are being recognized as one the major public health problems when you look at it from a worldwide projection in several western nations. Some studies show that hip fractures are mostly due to postmenopausal bone loss and osteoporosis in women. With osteoporosis being a major health problem especially among our growing population of the elderly, hip fractures contribute to both morbidity and mortality in the elderly.

1. Older Adults and Falls
There were nearly 258,000 patients in 2010 admitted to the hospital for hip fractures among the age 65 and older. More than over 90% were due to falling and falling sideways directly onto the hip. Scientists suggest that by 2030 the number of hip fractures due to falls will increase to 289,000, that an increase of 12%. Our elderly sometimes doesn’t bounce back due to hip injures. The increase death rates due to falls are associated with hip fractures. Some patients that lived alone before a fractured hip usually are confined to a nursing home for at least a year.

2. Who is more at risk for hip fractures white women vs. black women
Women are more prone to hip fractures than men, but men are more likely to die from a fall. With over 90% of hip fractures caused by falls, the rate for women is double compared to men. Rates also differ among different ethnic groups. Elderly non-Hispanics have higher fall rates than Hispanics. The risk factor for hip fracture in white women is one out of every six white women will have a hip fracture in their lifetime. A cohort study was assembled to identify the risk factors, measure bone mass and followed the women for hip fractures. The risk factor for hip fracture in black women is about half those in whites, but the rates are still considerable. The rates of mortality and disability after a fractured hip are higher among blacks than whites. At this time there were no in detail studies done on risk factors for hip fractures in black women, but increased bone mass is suspected to be the reason for the reduce incidence of hip fractures in black women. The reason for difference in the bone mass is unknown, but studies have explored the difference in hormone concentrations, body mass, body composition and calcium metabolism. A case control study was performed to identify the risk factors for hip fractures in black women.

3. Worldwide Geographic Variation
The demographic changes of the world has changed and there are more elderly living in the developing countries and it’s been estimated that by the year 2050 most of half of hip fractures will occur in Asia. A review was conducted using PubMed database to describe the incidence of hip fractures among different regions of the world and the causes of the wide geographic variation. The analysis gathered from these studies show a wide geographic variation across the globe, with industrialized countries having higher hip fracture incidence as compared to developing countries.

4. Hip Fractures and Menopausal Women
Bone mineral density decreases tremendously after menopause. As we age our bones begin to lose minerals and become less dense. This process weakens the bones and we become more prone to hip fractures. Women tend to lose more bone density than men as they age and since women constitute the majority of the elderly, three-quarters of hip fractures are seen in women. The reduction in bone mineral density is a major key factor for hip fractures in women. Usually women begin menopause in their early 50s, but it can occur at a younger age. Early menopause can be a risk factor for osteoporosis and fractures later on in life, but there is little to be known about how menopausal women influences hip fracture risk as women age. In this prospective study scientists investigate the incidence of hip fractures in relation to menopausal status and age among participants of the Million Women Study.

5. Mortality and Morbidity after Hip Fractures
Fractured hips are common injuries that results in substantial mortality, morbidity an expense. Almost one third of elderly patient who were independent become completely dependent on someone or something following a hip injury and one half may become partially dependent. The mortality rate is substantial. Nearly 20% of patients die within 3-6 months of a hip fracture and some studies have reported 30% die within 1 year. With improvements in technical advances and surgical treatment enhancements in outcome after having a hip fracture has been better, but further improvements of hip fracture outcome could be possible with the use of a clinical pathway designed to enhance outcomes in a standardized, cost effective manner. This pathway is based on a personal experience and literature associated to the treatment of elderly hip fracture patients. It gives an algorithmic approach to the patient that starts with an initial evaluation, pre-operative and operative management and finishes with post-operative treatment and rehabilitation.

Conclusion
As the elderly population increases hip fractures will continue to rise. The increase is partly due to falls among the elderly with decrease bone density. This phenomenon is seen worldwide especially in areas were the older populations will be more marked like Middle East, Europe, Asia, and Latin America. Also the incidence rate varies among race and population. More women sustain hip fractures than men and white women sustain more hip fractures than black women. Osteoporosis is one major risk factor resulting in falls causing hip fractures and I will be discussing what studies have found with this connection. Many elderly patients that were once independent before a hip fracture have to depend on someone or something to get around. They sometimes lose confidence and fear they may fall again which can lead to decrease mobility. With thousands of hip fractures occurring each year, 18%-33% die within 1 year of their due to complications. Reducing the risk of hip fractures is challenging and I think it may start with prevention, doing regular exercising like weight-bearing can preserve our bone mass in older adults and decrease the amount of falls in the elderly population.

Reference List
Banks, E., Reeves, G., Beral, V., Balkwill, A., Liu, B., & Roddam, A. (2009). Hip Fracture Incidence in Relation to Age, Menopausal Status, and Age at Menopause: Prospective Analysis. Plos Med, 6(11), e1000181. doi:10.1371/journal.pmed.1000181

Brauer, C. (2009). Incidence and Mortality of Hip Fractures in the United States. JAMA, 302(14), 1573. doi:10.1001/jama.2009.1462

Cdc.gov,. (2013). CDC – Older Adult Falls – Hip Fractures Among Older Adults – Home and Recreational Safety – Injury Center. Retrieved 13 February 2015, from https://www.cdc.gov/HomeandRecreationalSafety/Falls/adulthipfx.html

Dhanwal, D., Dennison, E., Harvey, N., & Cooper, C. (2011). Epidemiology of hip fracture: Worldwide geographic variation. Indian Journal Of Orthopaedics, 45(1), 15. doi:10.4103/0019-5413.73656

Koval, K., & Cooley, M. (2005). Clinical pathway after hip fracture, Disability and Rehabilitation, Informa Healthcare. Informahealthcare.com. Retrieved 13 February 2015, from https://informahealthcare.com/doi/abs/10.1080/09638280500056618

New England Journal of Medicine,. (2003). Risk Factors for Hip Fracture in Black Women — NEJM. Retrieved 13 February 2015, from https://www.nejm.org/doi/full/10.1056/NEJM199406023302202

New England Journal of Medicine,. (2015). Risk Factors for Hip Fracture in White Women — NEJM. Retrieved 13 February 2015, from https://www.nejm.org/doi/citedby/10.1056/NEJM199503233321202#t=citedby

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