Preventing Hip Fractures in Older P...

Preventing Hip Fractures in Older Patients with Fall Risk

TO THE EDITOR: The article summary titled "Preventing Falls: Which Intervention Is chiefly Effective?" (1) in the Tips from Other Journals section of American Family Physician reviews a prospective application of mind (2) that concludes that exercise cut shorts the risk of falls in somewhat old persons who live at fireside The greatest morbidity from falls is hip fracture, and 90 percent of hip fractures originate from falls. (3) The reviewed application of mind (2) is concordant with a cohort close attention (4) that suggested a 36 percent reduction in hip fracture risk in older women who maintained physically active lifestyles compared with those who were sedentary (after adjusting for potential confounding variables of that kind as functional status, general health, and other personal habits).

In the reviewed studious mood (2) 63.5 percent of someones in the control group had at least undivided fall during the 18-month subject of attention period. Among persons whose intervention included exercise, vision management, and to one's home hazard management, 48.1 percent had at least undivided fall during the 18-month reflection period. (2) Even with interventions, nearly single in kind half of the subjects had at least common fall.

Because of the morbidity from falls, specifically hip fracture, examination of older patients should include assessment for risk of falls. In addition to assessing vision, ambulatory dysfunction may be evident in succession direct observation of gait. Balance difficulties can be assessed (instability upon Romberg testing), as well as quadriceps muscle weakness (observable when rising from a chair, without use of the upper extremities, starting with hips and knee each at 90 grades flexion).

An intervention that has been demonstrated to dramatically form hip fracture risk with falls in high-risk clusters is the use of hip protectors. (56) The relative hazard of a hip fracture in human frames wearing hip protectors was 04 which exhibited a 60 percent reduction in hip fractures. Interestingly, of the 13 hip fractures among exposes in the hip protector intervention cluster only four occurred while the controls were wearing hip protectors. In the hip protector cluster four hip fractures occurred in 1034 falls while exposes were wearing protectors, and nine fractures occurr in 370 falls when bring under rules were not wearing protectors; this consequence ed in a relative hazard ratio of 02 when wearing hip protectors. Overall, hip protectors would have been staggeringly effective had they been worn faithfully 24 hours for day in the intervention collection No difference was noted in fractures between the arranges except for hip fractures. Patients who are at risk of falls should have enough pairs of hip protectors to allow them to wear them continuously, including at night (when a fate of hip fractures occur). The principle behind the use of hip protectors is the same as wearing protective gear when playing various sports.

For my somewhat old patients, I advise exercise, calcium, vitamin D avoidance of alcohol and tobacco, family circle hazard reduction (including excellent lighting, nonskid footwear and nonskid surfaces, and removal of obstructions including twist together rugs), visual examinations, dual capacity of work x-ray absorptiometry scans (and later treatment if appropriate), and hip protectors. I commonly have elderly patients who describe feeling insecure when not wearing their hip protectors.

REFERENCES

(1) Walling AD. Preventing falls: which intervention is chiefly effective? [Tips] Am Fam Physician 2002;66: 1967-71

(2) Day L Fildes B Gordon I, Fitzharris M Flamer H Lord s Randomised factorial trial of falls prevention among older race living in their own households BMJ 2002;325:128-31.

(3) Miller PD The treatment of osteoporosis. Anti resorptive therapy. Clin Lab M 2000;20:603-22

(4) Gregg EW Cauley JA, Seeley DG Ensrud KE Bauer DC Physical activity and osteoporotic fracture risk in older women research of Osteoporotic Fractures Research form into groups Ann Intern Med 1998;129:81-8.

(5) Kannus P Parkkari J Niemi s Pasanen M, Palvanen M, Jarvinen M et al. Prevention of hip fracture in somewhat old people with use of a hip protector. N Engl J M 2000;343:1506-13

(6) Rubenstein L Hip protectors-a breakthrough in fracture prevention. N Engl J M 2000;343:1562-3

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