Management of osteoporosis in patients with hip fractures.

Abstract

Hip fractures are a major cause of excess mortality, morbidity and health and social service expenditure in elderly people.1 Patients who survive hip fractures are at high risk of further fracture,2,,3 yet most receive no treatment for osteoporosis or advice on reducing falls. A number of guidelines on the management of osteoporosis have been published, but these contain little specific advice on the management of patients with hip fracture.4–,6 A group of physicians from the North‐East of England interested in osteoporosis has therefore met on a number of occasions, to develop practical advice on the management of osteoporosis in patients with hip fractures. Bone is lost with advancing age in both men and women, leading to an increased risk of fractures after minimal trauma. The major osteoporotic fractures are those of the forearm, vertebral body and hip. Each year, about 60 000 hip fractures occur in the UK, causing excess mortality, substantial morbidity and vast health and social service costs. The lifetime risk of hip fracture in the UK been estimated at 14% for a 50‐year‐old woman and 3% for a 50‐year‐old man,1 although these figures may be underestimates, because of declining mortality in the elderly.7 The excess mortality after hip fracture is 10–20%,1,8,,9 which may be related in part to co‐morbidity. There is also considerable morbidity after hip fractures, as 25–50% of patients become more dependent, many of whom require placement in a residential or nursing home.10, ,11The annual cost of osteoporotic fractures in the UK has been estimated at £942m, of which 87% is due to hip fractures.12 The risk of hip fractures is determined not only by bone mineral density (BMD), but also by factors associated with physical frailty and an …