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Published on: August 17, 2017
Hip fracture in elderly men: prognostic factors and outcomes
T H Diamond1, S W Thornley, R Sekel
1St George Hospital, Sydney, NSW.
Insights
Elderly men with hip fractures experience higher mortality and more osteoporosis risk factors than women. Their physical function significantly declines post-fracture, indicating poor outcomes.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Public Health
Background:
- Hip fractures are a significant health concern in the elderly population.
- Understanding prognostic factors is crucial for improving patient outcomes.
- Men are often underrepresented in hip fracture research.
Purpose of the Study:
- To investigate prognostic factors and outcomes in men aged 60 and older following a hip fracture.
- To compare outcomes between male and female hip fracture patients.
Main Methods:
- A cohort study involving 51 men aged 60+ with hip fractures, compared to 51 age-matched women.
- Data collected retrospectively from medical records and prospectively at 6 and 12 months post-fracture.
- Assessed prognostic factors (comorbidities, osteoporosis risk) and outcomes (complications, mortality, Barthel index).
Main Results:
- Men had a higher in-hospital mortality rate (14% vs. 6%) and more osteoporosis risk factors (P < 0.01).
- Physical functioning, measured by the Barthel index, significantly declined in men post-fracture (P < 0.05).
- Similar proportions of men and women required institutionalization or experienced fracture-related complications.
Conclusions:
- Elderly men with hip fractures exhibit higher mortality and greater osteoporosis risk compared to women.
- Pre-existing medical conditions and fracture complications contribute to poor outcomes in both sexes.
- Hip fracture management in elderly men requires attention to osteoporosis and functional decline.
Objective:
To examine prognostic factors and outcomes after hip fracture in men aged 60 years and older.
Design And Setting:
Cohort study of all men presenting to St George Hospital (a 650-bed tertiary care centre) with hip fractures in 1995, recruited retrospectively from medical records and evaluated prospectively at six and 12 months after fracture.
Patients:
51 men aged 60 years or more (and, for comparison, 51 age-matched women) who presented with hip fracture not caused by high impact injuries or local bone disease.
Main Outcome Measures:
Prognostic factors (such as pre-existing illness and osteoporotic risk factors) and outcome data (such as fracture-related complications, mortality, and level of function as measured by the Barthel index of activities of daily living at six and 12 months postfracture).
Results:
Median age of the 51 men was 80 years (interquartile range, 74-86 years); four were aged under 70 years. Outcome assessment was possible for 41 men (80%). Similar proportions of men and women came from institutions (32% v. 28%), and similar additional proportions required institutionalisation after discharge (18% v. 14%). Fracture-related complications affected similar proportions of men and women (30% v. 32%), and mean length of hospital stay was similar. Fourteen per cent of men died in hospital compared with only 6% of women (P = 0.06). Men had more risk factors for osteoporosis (P < 0.01). Physical functioning (measured by the Barthel index) deteriorated significantly in men from 14.9 at baseline to 13.4 at six months (P < 0.05) and 12.4 at 12 months (P < 0.05) after fracture.
Conclusion:
Compared with women, elderly men presenting with hip fracture have higher mortality and have more risk factors for osteoporosis. Like women with hip fracture, men are usually fragile, with pre-existing medical illness and fracture-related complications contributing to their overall poor outcomes.
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