J Korean Med Assoc.  2016 Aug;59(8):631-636. 10.5124/jkma.2016.59.8.631.

Strategies for prevention of elderly hip fracture

• Kim Y

• KMID: 2349840
• DOI: http://doi.org/10.5124/jkma.2016.59.8.631

Abstract

One of the severe complications of osteoporosis is hip fracture, which can occur even with minimal trauma. This burdensome complication is closely associated with an increased risk of mortality, impairment, and decreased quality of life, resulting in enormous health care costs. Hip fracture is significantly related to a previous history of fracture, and its risk can be determined by bone strength and type of trauma-with falls posing an especially high risk. The first step to prevent osteoporotic fracture is the detection of osteoporosis, relying on the quantification of bone density via imaging techniques such as dual-energy X-ray absorptiometry and quantitative computed tomography. In addition, various preventive strategies have been introduced. Above all, proper supplementation of vitamin D, protein, milk, calcium, folic acid, vitamin B12, and vitamin K is beneficial for prevention of osteoporotic fracture for elderly patients who are susceptible to nutrition imbalance. For elderly patients, rehabilitation is considered to be crucial for increasing function and improving patients' activities of daily living as well. A fall-preventive intervention program has been known to be the effective and useful way for elderly patients to reduce fall risk, which can be assessed with the 'timed up and go' test. A home hazard modification program such as wearing anti-slip shoe devices has been proven to decrease fall risk in community-living elderly. Therefore, diagnosis of osteoporosis, proper supplementation of nutrients, rehabilitation, and a fall-preventive intervention program are essential components in the prevention of hip fracture.

Keyword

Aged; Osteoporosis; Hip fractures

MeSH Terms

Absorptiometry, Photon
Accidental Falls
Activities of Daily Living
Aged*
Bone Density
Calcium
Diagnosis
Folic Acid
Health Care Costs
Hip Fractures
Hip*
Humans
Milk Proteins
Mortality
Osteoporosis
Osteoporotic Fractures
Quality of Life
Rehabilitation
Shoes
Vitamin B 12
Vitamin D
Vitamin K
Calcium
Folic Acid
Milk Proteins
Vitamin B 12
Vitamin D
Vitamin K

Reference

1. Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, Melton LJ 3rd. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993; 137:1001–1005.

2. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000; 15:721–739.

3. Cumming RG. Nursing home residence and risk of hip fracture. Am J Epidemiol. 1996; 143:1191–1194.

4. Brennan nee Saunders J, Johansen A, Butler J, Stone M, Richmond P, Jones S, Lyons RA. Place of residence and risk of fracture in older people: a population-based study of over 65-year-olds in Cardiff. Osteoporos Int. 2003; 14:515–519.

5. Berry SD, Samelson EJ, Ngo L, Bordes M, Broe KE, Kiel DP. Subsequent fracture in nursing home residents with a hip fracture: a competing risks approach. J Am Geriatr Soc. 2008; 56:1887–1892.

6. Papaioannou A, Wiktorowicz M, Adachi JD, Goeree R, Papadimitropoulos E, Bedard M, Brazil K, Parkinson W, Weaver B. Mortality, independence in living, and re-fracture, one year following hip fracture in Canadians. J SOGC. 2000; 22:591–597.

7. Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Jarvinen M. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int. 1999; 65:183–187.

8. Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, Wolfson C. Frailty: an emerging research and clinical paradigm: issues and controversies. J Gerontol A Biol Sci Med Sci. 2007; 62:731–737.

9. Bischoff-Ferrari HA, Can U, Staehelin HB, Platz A, Henschkowski J, Michel BA, Dawson-Hughes B, Theiler R. Severe vitamin D deficiency in Swiss hip fracture patients. Bone. 2008; 42:597–602.

10. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW, Dawson-Hughes B. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. Am J Clin Nutr. 2004; 80:752–758.

11. Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992; 327:1637–1642.

12. Schurch MA, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour JP. Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1998; 128:801–809.

13. Sahni S, Tucker KL, Kiel DP, Quach L, Casey VA, Hannan MT. Milk and yogurt consumption are linked with higher bone mineral density but not with hip fracture: the Framingham Offspring Study. Arch Osteoporos. 2013; 8:119.

14. Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Kanis JA, Orav EJ, Staehelin HB, Kiel DP, Burckhardt P, Henschkowski J, Spiegelman D, Li R, Wong JB, Feskanich D, Willett WC. Milk intake and risk of hip fracture in men and women: a meta-analysis of prospective cohort studies. J Bone Miner Res. 2011; 26:833–839.

15. Misra D, Berry SD, Broe KE, McLean RR, Cupples LA, Tucker KL, Kiel DP, Hannan MT. Does dietary protein reduce hip fracture risk in elders? The Framingham Osteoporosis Study. Osteoporos Int. 2011; 22:345–349.

16. Kim KM, Choi HS, Choi MJ, Chung HY. Calcium and Vitamin D Supplementations: 2015 Position Statement of the Korean Society for Bone and Mineral Research. J Bone Metab. 2015; 22:143–149.

17. Wang X, Chen H, Ouyang Y, Liu J, Zhao G, Bao W, Yan M. Dietary calcium intake and mortality risk from cardiovascular disease and all causes: a meta-analysis of prospective cohort studies. BMC Med. 2014; 12:158.

18. Alegre-Lopez J, Cordero-Guevara J, Alonso-Valdivielso JL, Fernandez-Melon J. Factors associated with mortality and functional disability after hip fracture: an inception cohort study. Osteoporos Int. 2005; 16:729–736.

19. Williams CS, Tinetti ME, Kasl SV, Peduzzi PN. The role of pain in the recovery of instrumental and social functioning after hip fracture. J Aging Health. 2006; 18:743–762.

20. Geusens P, Autier P, Boonen S, Vanhoof J, Declerck K, Raus J. The relationship among history of falls, osteoporosis, and fractures in postmenopausal women. Arch Phys Med Rehabil. 2002; 83:903–906.

21. Nevitt MC, Cummings SR, Hudes ES. Risk factors for injurious falls: a prospective study. J Gerontol. 1991; 46:M164–M170.

22. Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing. 2005; 34:614–619.

23. Kristensen MT, Foss NB, Kehlet H. Timed "up & go" test as a predictor of falls within 6 months after hip fracture surgery. Phys Ther. 2007; 87:24–30.

24. Sjosten NM, Salonoja M, Piirtola M, Vahlberg T, Isoaho R, Hyttinen H, Aarnio P, Kivela SL. A multifactorial fall prevention programme in home-dwelling elderly people: a randomized-controlled trial. Public Health. 2007; 121:308–318.

25. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing. 1999; 28:513–518.

26. Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J. Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc. 2005; 53:1476–1482.

27. Mendelsohn ME, Overend TJ, Connelly DM, Petrella RJ. Improvement in aerobic fitness during rehabilitation after hip fracture. Arch Phys Med Rehabil. 2008; 89:609–617.