Hip fracture—aspects of background factors and outcome

There are no definitive laboratory tests for osteoporosis, and little is known of their age-related variation. Furthermore, the knowledge of factors contributing to the occurrence of hip fracture, the most important complication of osteoporosis, during the fall is insufficient. Hip fracture is known to impair the function of elderly patients considerably at short term, but here is only limited information of the potential permanence of this impairment. The goal of treatment is to restore the patient's prefracture lifestyle. In this respect, intensive rehabilitation has been recommended and applied in many institutions. However, the number of critical reports on this topic is limited, and the results are heterogeneous. An assessment of the effects of age on some commonly used parameters of bone metabolism in females was performed on 238 healthy Caucasian women aged 40–86 years. It was observed that the markers of bone formation, alkaline phosphatase and osteocalcin, and the marker of bone resorption, tartrate-resistant acid phosphatase (TRACP) as well as parathyroid hormone (PTH), phosphorus and creatinine increased with age, whereas 25-hydroxyvitamin D [25(OH)D] and oestradiol decreased. All these parameters except calcium showed a significant age relation. An evaluation of the factors contributing to the occurrence of hip fracture during a fall on the hip was performed by comparing 123 hip fracture patients to 132 persons who had experienced a fall that caused a visible soft tissue injury in the hip or gluteal region without a fracture. The hip fracture patients more commonly than the fallers were women, lived in long-term institutional care, had had previous stroke with hemiparesis, had Parkinsonism, used neuroleptics, were dependent in ADL and had lower body mass indexes. According to the logistic regression model, institutional residence, low body mass index and a history of stroke with hemiplegic status differed between the fracture cases and controls. The long-term effects (mean follow-up 7 years) of trochanteric hip fracture on outcome were studied by comparing 200 consecutive patients (mean age 77 years) and ageand sex-matched controls representing the average population from the same area. Mortality increased gradually, being 4.5% above the control level at one month and 9% at six years after the fracture. 48% the surviving patients and 90% of the surviving controls were still living in their own homes or service apartments ,whereas 48% of the patients and 5% of the controls were instutionalized. The ambulatory capacity of the patients was significantly worse than controls. The patients managed their ADL activities significantly less well, required more home help and had fewer social contacts and outdoor hobbies than the controls. An assessment of the effect of intensive rehabilitation on the coping of hip fracture patients was done in a prospective randomised study on 154 patients, half of whom were treated postoperatively in a rehabilitation clinic and the other half at health care centre hospitals. Seven of the 70 survival patients of the rehabilitation group 5 of the 71 respective controls were institutionalized at one year. No difference was either observed in the walking ability or ADL functions between the groups.