Risk factors for falls as a cause of hip fracture in the elderly

Almost all epidemiologic studies have shown that the age-adjusted incidence of osteoporotic hip fracture has been increasing during the last decades. Although the age-related bone loss is considered to be a crucial determinant of the incidence of hip fracture, spontaneous fractures appear to be uncommon: about 90% of hip fractures in the elderly result from a fall. This article focuses on the different risk factors for falls. Poor health status (especially chronic illness), impaired mobility and postural instability, and a history of prior falls have been associated with the risk of falling. Balance can also be impaired by disease (such as a broad spectrum of ophthalmologic and neurologic disorders) or age-related changes in number of anatomical structures, by medications which reduce their efficient functioning (such as some psychotropic or antihypertensive drugs) and by environmental hazards. The identification of elderly patients at risk for falling and intervention to minimize risk without compromising functional independence should receive a high priority in the health care of elderly persons.