Twenty-five Years Before the Fall: Preventing Osteoporotic Hip Fracture

Osteoporosis is a common entity, especially among elderly Caucasian women. Osteoporosis leads to hip fracture in many persons, putting them at risk for death and marked handicap. Hip fracture shows a steady increase in incidence after age 60 years, and most of the victims are over age 75 years. Screening studies predict hip fracture up to 8 years before fracture. Estrogen therapy, to be effective, should be initiated between the ages of 50 and 60 years, 25 to 15 years before the most likely age of fracture. Guidelines describing for whom the physician targets estrogen therapy, which is not without risks, are sketchy or nonexistent. The patient should also be educated as a young adult about risk factor modification for osteoporosis, including increasing exercise, ceasing smoking, and minimizing coffee and alcohol use.