HIP FRACTURE IN ELDERLY MEN - PROGNOSTIC FACTORS AND OUTCOMES

Objective: To examine prognostic factors and outcomes after hip fractu re 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 cen tre) with hip fractures in 1995, recruited retrospectively from medica l records and evaluated prospectively at six and 12 months after fract ure. Patients: 51 men aged 60 years or more (and, for comparison, 51 a ge-matched women) who presented with hip fracture not caused by high i mpact injuries or local bone disease. Main outcome measures: Prognosti c 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 o f daily living at six and 12 months postfracture). Results: Median age of the 51 men was 80 years (interquartile range, 74-86 years); four w ere aged under 70 years. Outcome assessment was possible for 41 men (8 0%). Similar proportions of men and women came from institutions (32% v. 28%), and similar additional proportions required institutionalisat ion after discharge (18% v. 14%). Fracture-related complications affec ted similar proportions of men and women (30% v. 32%), and mean length of hospital stay was similar. Fourteen per cent of men died in hospit al compared with only 6% of women (P=0.06). Men had more risk factors for osteoporosis (P<0.01). Physical functioning (measured by the Barth el index) deteriorated significantly in men from 14.9 at baseline to 1 3.4 at six months (P < 0.05) and 12.4 at 12 months (P < 0.05) after fr acture. Conclusion: Compared with women, elderly men presenting with h ip fracture have higher mortality and have more risk factors for osteo porosis. Like women with hip fracture, men are usually fragile, with p re-existing medical illness and fracture-related complications contrib uting to their overall poor outcomes.