Hip Fracture: A Disease and an Accident

Abstract

It has long been debated whether hip fractures are best thought of as disease, ie, osteoporosis, or accident. Most investigators believe that age-related bone loss accounts for the rise in hip fracture incidence among the elderly (Consensus Conference 1984), and it has even been suggested that, as a result of osteoporosis, hip fractures can occur without a fall (Reeves, 1977; Smith, 1953). Others claim that osteoporosis has little etiologic relationship to hip fracture risk (Aitken, 1984; Cummings, 1985; Evans et al, 1981; Wicks et al, 1982) and that other determinants such as risk factors for falls are all important (Aitken, 1984; Wicks et al, 1982). We believe, however, that both osteoporosis and trauma are important in the production of hip fractures and that neither alone can completely account for the rise in hip fracture incidence with age. This point of view is based on the evidence outlined below.