Characteristics of falls and risk of hip fracture in elderly men

The steep rise in hip fracture incidence rates with age is not fully explai ned by an increase in the frequency of falls or by reduction in bone minera l density, suggesting that circumstances of falls may also affect the risk of hip fracture. previous studies conducted mainly among women have identif ied the importance of the orientation of a fall in the etiology of hip frac ture. In this case-control study among men of 45 years and older, Eve evalu ated how the circumstances of falls affect the risk of hip fracture. We com pared 213 cases with hip fracture due to a fall with 86 controls who had fa llen within the past year but did not sustain a hip fracture. As expected, in multivariable age-adjusted analyses men who reported hitting the hip/thi gh in a fall had a markedly elevated risk of hip fracture (OR = 97.8; 95% C I = 31.7-302). Hitting the knee in a fall was associated with reduced risk (OR = 0.24; 95% CI = 0.09-0.67). Other factors that were associated with re duced risk of hip fracture among men who fell were more hours of physical a ctivity in the past year (OR = 0.84; 95% CI = 0.73-0.97, for each additiona l 4 h per week), a greater body mass index (OR = 0.60; 95% CI = 0.40-0.90, for each additional 4 kg/m(2)), and a history of a fracture when age 45 yea rs or older (OR = 0.26; 95% CI = 0.10-0.69). Reported lower limb dysfunctio n was associated with increased risk of hip fracture (OR = 6.41; 95% CI = 2 .09-19.6) among fallers, The increased risk associated with hitting the hip /thigh in a fall and the reduced risk associated with high body mass index suggest that preventive efforts for older men at high risk might include pr otective hip pads to reduce the force on the hip in a fall. Exercise and st rength training programs may also reduce the risk of hip fracture among men who fall.