Epidemiology
In the UK, around 76,000 hip fractures occur each year.[10] Patients recovering from hip fracture occupy 4000 NHS beds at any one time.[11] The risk of hip fractures increases exponentially with age, and they are more frequent in those more than 65 years of age, with the average age being approximately 83 years.[11][12] The predominant mechanism of injury is a fall from a standing height.[12][13][14] The incidence of falls in older people can be as high as 30% to 60% and is higher for those in an institution.[15][16] 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 seen.[12][17] Hip fractures can occur in association with femoral shaft fractures in 2% to 6% of cases.[18] These are termed ipsilateral femoral neck and shaft fractures. They typically occur as a result of high-energy trauma in young adults.[19]
Risk factors
There is an almost threefold increase in the risk of hip fractures for both men and women for each decrease of 1 standard deviation below peak bone mass values.[27][28] See Osteoporosis.
The predominant mechanism of injury is a fall from a standing height.[12][13][14] The incidence of falls in older people can be as high as 30% to 60%, and is higher for those in an institution.[15][16] 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.[29][30] See Assessment of falls in the elderly.
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 twofold increase in the risk of hip fracture; however, this relationship was determined to be non-linear.[31]
Using Swedish population data, the projected lifetime risk of sustaining a hip fracture is 11.1% for men and 22.7% for women.[32]
In younger patients, the primary aetiology is high-energy trauma including motor vehicle accidents and falls from height.[17]
Some drugs increase the risk of fracture, including levothyroxine (decreased bone density), loop diuretics (impair calcium absorption in the kidney), proton-pump inhibitors (reduce calcium absorption), and corticosteroids (long-term use can lead to osteoporosis).[29][33][34] Medications that cause sedation (e.g., antidepressants, opioid analgesics) or postural hypotension (antihypertensives) increase the risk of falls.[29][35]
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