NEJM Clinical Pearls 2007/10/31
Q: In a patient who sustains a hip fracture, what is the risk for subsequent fracture and/or death?
A: Persons who fracture a hip are 2.5 times as likely to have a subsequent skeletal fracture as are those without a hip fracture. In patients who have sustained a hip fracture, there is an increase in mortality; a 2-year mortality rate of 36% has been observed. Mortality in the year after hip fracture has been reported to cause an estimated 9 excess deaths per 100 patients among women 70 years and older. Many of those who survive do not regain their prefracture level of mobility and thereby endure loss of independence and deterioration in health-related quality of life.
Q: What types of treatment (drug and non-drug) are currently used to prevent hip fractures?
A: Treatment to prevent hip fractures includes bisphosphonates (oral and intravenous), vitamin D and calcium supplementation, nasal calcitonin, selective estrogen-receptor modulators, hormone replacement, tibolone (a synthetic steroid), and padded hip protectors. Home safety (removal of risks in the home such as loose rugs) strength-training and balance/coordination exercises have also been recommended.