Epidemiology
In the US, there are between 260,000 and 300,000 admissions for hip fractures each year.[7]
The risk of hip fractures increases significantly with age.[8] They occur more frequently in those older than 65 years of age, with the average age being approximately 78 years.[9][10] Using Swedish population data, the projected lifetime risk of sustaining a hip fracture is 11.1% for men and 22.7% for women.[11]
The predominant mechanism of injury is a fall from a standing height.[9][12][13] The incidence of falls in older people can be as high as 30% to 60% and is higher for those in an institution.[14][15] Hip fractures in those younger than 40 years of age are more commonly from high-energy trauma (e.g., motor vehicle accident) and occur predominantly in males; however, these account for only 1% to 3% of hip fractures.[9][16]
The number of hip fractures in older adults that occur globally is expected to increase from 1.26 million in 1990 to 4.5 million by 2050 as the world’s population ages.[17][18]
Risk factors
There is an almost 3-fold increase in the risk of proximal femoral fractures for both men and women for each decrease of 1 standard deviation below peak bone mass values.[23][31] See Osteoporosis.
The predominant mechanism of injury is a fall from a standing height.[9][12][13] The incidence of falls in older people can be as high as 30% to 60%, and is higher for those in an institution.[14][15]
Gait and balance problems, muscle weakness, visual impairment, cognitive impairment, depression, functional decline, and particular medications are the most common underlying causes and risk factors for falls.[14][17][33]
Body mass index (BMI) may contribute to hip fracture risk. When compared with a BMI of 25 kg/m², a BMI of 20 kg/m² has been associated with a nearly 2-fold increase in the risk of hip fracture; however, this relationship was determined to be nonlinear.[34]
Using Swedish population data, the projected lifetime risk of sustaining a hip fracture is 11.1% for men and 22.7% for women.[11]
In younger patients, the primary etiology is high-energy trauma including motor vehicle accidents and falls from height.[16]
Some drugs increase the risk of fracture including levothyroxine (decreased bone density), loop diuretics (impair calcium absorption in kidney), proton-pump inhibitors (reduce calcium absorption), and corticosteroids (long-term use can lead to osteoporosis).[33][35][36] Medications that cause sedation (e.g., antidepressants, opioid analgesics) or postural hypotension (e.g., antihypertensives) increase the risk of falls.[33][37]
Lifetime risks for hip fracture in a study using dual-energy x-ray absorptiometry (DXA) measurements of femoral bone mineral density were 17% for white Americans, 14% for Hispanic Americans, and 6% for black Americans.[31][38] However, accurate estimates are difficult to obtain, because racial disparities exist in the care of osteoporosis.[39] One study showed black women were 40% less likely than white women to be screened for osteoporosis using DXA.[40]
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