RISK-FACTORS FOR HIP-FRACTURES - A REVIEW

Risk factors for hip fracture have been reviewed based on case-control and prospective follow-up studies. Falls with impact to the hip, the capacity of energy absorption in soft tissue, and bone strength are cl osely linked to the risk of hip fracture. Consistently documented risk factors are age, sex, race, low bone mass, low body weight, estrogen deficiency and earlier fracture. Other risk factors are tendency to fa ll, disability and immobilisation, low physical activity, use of psych otropic/anxiolytic/hypnotic drugs, use of corticosteroid, low calcium intake in the elderly, osteomalacia, thyreotoxicosis, cigarette smokin g, chronic alcoholism, diabetes mellitus, insufficient sunlight exposu re and a protective effect from thiazide diuretics. Evidence is lackin g for risk factors such as heredity, nutrition and medical conditions. No information is available on the combined effects of the different risk factors. Risk estimation of hip fractures should focus on the ris k of falls, the capacity of energy absorption and the bone strength. R ecent studies indicate that the prevention of hip fractures is realist ic, even in the elderly and definitely osteoporotic population when th ese fundamental risk factors are modified, which has been shown in con trolled trials in nursing homes by vitamin D and calcium supplementati on or by wearing external hip protectors.