Epidemiology of Hip Fractures - Manoj Ramachandran 16/8/2000
Background epidemiology
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1.7 million/year worldwide
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Projection of 6.3 million by 2050 (due to increase in elderly population
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1-year survival rate 85%
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Estimated lifetime risk 14% in postmenopausal women and 6% in men
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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
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Author
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Lauritzen JB (University of Copenhagen, Denmark)
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Title
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Hip fractures: Incidence, risk factors, energy absorption, and prevention
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Reference
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Bone 1996; 18(1): 65S-75S
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Summary
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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)
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Critique
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Prospective randomised study (247 study, 418 control from nursing homes) over 11 months but ?decreased compliance outside nursing homes
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RISK FACTORS
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Author
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Chan KA, Andrade SE, Bole M
et al.
(Harvard Medical School, Boston)
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Title
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Inhibitors of HMGCoA reductase and risk of fracture among older women
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Reference
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Lancet 2000; 355: 2185-88
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Summary
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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)
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Critique
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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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