HIP-FRACTURES - INCIDENCE, RISK-FACTORS, ENERGY-ABSORPTION, AND PREVENTION

The present review summarizes the pathogenic mechanisms leading to hip fracture based on epidemiological, experimental, and controlled clini cal studies, The estimated lifetime risk of hip fracture is about 14% in postmenopausal women and 6% in men, The incidence of hip fractures increases exponentially with aging, but the time trend in increasing a ge-specific incidence may finally reach a plateau, Postmenopausal wome n suffering earlier non-hip fractures have an increased risk of later hip fracture, The relative risk is highest within the first years foll owing the fracture, Nursing home residents have a high risk of hip fra cture (annual rate of 5-6%), and their incidence of falls is about 1.5 falls/person per year, Most hip fractures are a result of a direct tr auma against the hip, The incidence of falls on the hip among nursing home residents is about 0.29 falls/person per year and about 20% of th ese traumas lead to hip fracture, Women with hip fractures have a lowe r body weight compared with controls, and they may also have less soft tissue covering the hip, even when adjusted for body mass index, indi cating a more android body habitus, Experimental studies show that the passive energy absorption in soft tissue covering the hip may influen ce the risk of hip fracture and be an important determinant for the de velopment of hip fracture, perhaps even more important than bone stren gth, External hip protectors were developed and tested in an open rand omized nursing home study, The rate of hip fracture was reduced by 50% , corresponding to 9 of 247 residents saved from sustaining a hip frac ture, This review points to the essentials in the development of hip f racture: risk of fall; type of fall; type of impact; energy absorption ; and last, bone strength, which is the final permissive factor leadin g to hip fracture, Risk estimation and prevention of hip fracture may prove realistic when these issues are taken into consideration.