Factors associated with hip fracture occurrence in old age. Implications in the postsurgical management

Fractures of the proximal femur (intracapsular as well as trochanteric fractures) are the most devastating complication of osteoporosis. These fractures are not only associated with significant morbidity, but also with a severe risk of death (+/- 25%) within one year. The strongest predisposing factor for fractures of the proximal femur is low bone density. In addition, numerous studies provide evidence that several other factors, independently, contribute to hip fracture risk, including low body mass index, previous fractures, muscle weakness, impaired vision, cognitive impairment, history of hyperthyroidism, use of long-acting sedatives, and physical inactivity. These findings indicate the need for preventive strategies based on risk factor modification and also on measures to maintain bone density. In view of the growing incidence of subsequent fracture of the contralateral hip, preventive strategies should be initiated in all these patients as an integral part of the postsurgical management during the acute hospital stay. These strategies should not only include combined supplements of calcium and vitamin D to attenuate further bone loss, but also a comprehensive assessment of risk factors.