Strategy for Prevention of Hip Fractures in Patients with Alzheimer\\\\\\\'s Disease

Abstract

The incidence of fractures, particularly hip fractures, is known to be high in patients with Alzheimer’s disease. The aim of this review was to clarify the efficacy of interventions against hip fractures in patients with Alzheimer’s disease. The literature was searched using PubMed for randomized controlled trials (RCTs) regarding Alzheimer’s disease and hip fractures. Four RCTs were identified, and the relative risk (RR) and 95% confidence interval (CI) were calculated for the individual RCTs. Sunlight exposure increased the serum level of 25-hydroxyvitamin D, promoted muscle strength, and prevented falls. Menatetrenone (vitamin K2) with vitamin D supplementation decreased the serum level of undercarboxylated osteocalcin. Risedronate with vitamin D supplementation decreased the urinary level of deoxypyridinoline. Sunlight exposure, menatetrenone, and risedronate reduced the incidence of hip fractures, with RR (95% CI) of 0.22 (0.049, 0.999), 0.13 (0.031, 0.554), and 0.28 (0.105, 0.732), respectively. Combined treatment with risedronate and menatetrenone was more effective in preventing hip fractures than single treatment with risedronate, with RR (95% CI) of 0.19 (0.044, 0.858). However, the quality of RCTs was the highest in two risedronate studies which adopted a placebo control group. The present review of the literature implies that sunlight exposure, menatetrenone, and risedronate act on the musculoskeletal system in different manners for preventing hip fractures in patients with Alzheimer’s disease. However, risedronate plus vitamin D supplementation or risedronate plus menatetrenone can be candidates in patients with Alzheimer’s disease.