Epidemiology of Hip Fractures - Manoj Ramachandran 16/8/2000

Background epidemiology

  • 1.7 million/year worldwide
  • Projection of 6.3 million by 2050 (due to increase in elderly population
  • 1-year survival rate 85%
  • Estimated lifetime risk 14% in postmenopausal women and 6% in men
  • Several known risk factors including age, sex, race("white women"), low bone mass, oestrogen deficiency, low physical activity, use of psychotropic/anxiolytic, hypmotic drugs, low calium intake in the elderly, thyrotoxicosis, chronic alcoholism, diabetes mellitus, stroke and tobacco smoking

KEY REFERENCE

Author Lauritzen JB (University of Copenhagen, Denmark)
Title Hip fractures: Incidence, risk factors, energy absorption, and prevention
Reference Bone 1996; 18(1): 65S-75S
Summary Review article on epidemiology as above, also concludes that hip protectors reduce rate of hip fractures by 50% (outer shield of stiff polypropylene and inner soft plastozote, fixed in special underwear)
Critique Prospective randomised study (247 study, 418 control from nursing homes) over 11 months but ?decreased compliance outside nursing homes

RISK FACTORS

Author Chan KA, Andrade SE, Bole M et al. (Harvard Medical School, Boston)
Title Inhibitors of HMGCoA reductase and risk of fracture among older women
Reference Lancet 2000; 355: 2185-88
Summary Statins are protective against non-pathological fractures (including hip) in older women as a result of increased bone mineral density (use of statins during 2 years prior to the fracture= 50%reduction in risk)
Critique Population-based case control study (928 cases, 2747 controls), so ?length of exposure required; effect may be due to higher body mass index, smoking, lack of exercise



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