Pharmacologic and Non-pharmacologic Strategies to Prevent Hip Fracture in Old Age

Summary

• Strategies for the prevention of hip fracture should focus on the frequency of falling as well as on the prevalence of compromised femoral integrity as a consequence of bone loss.

• Given the high prevalence of falls among the elderly, a performance-oriented functional assessment should be targeted at all patients over 75 years of age. As the risk of falling increases with the number of risk factors, risk may be reduced by modifying even a few contributing factors.

• Intervention studies have indicated the need to provide adequate supply of both calcium (1500mg daily) and vitamin D (400–800 IU daily) in old age, particularly in housebound elderly and nursing home residents.

• Bisphosphonate treatment reduces the risk of hip fracture among elderly women with confirmed osteoporosis but is not more effective than calcium and vitamin D alone in women identified primarily on the basis of risk factors other than low BMD.

Hip fractures among the elderly are a worldwide epidemic, and the number of these fractures is expected to rise dramatically as the population ages. In addition to high financial costs, femoral neck fractures are associated with high morbidity, high risk for long-term institutionalization, and increased risk of death. Considering the magnitude of the problem, any substantial reduction in the hip fracture burden depends on prevention. In view of the complex pathogenesis of hip fractures, preventive strategies should focus on the frequency and impact of falling in the elderly as well as on the prevalence of compromised femoral integrity as a consequence of bone loss.