Factors associated with hip fracture occurrence in old age. Implications in the postsurgical management

Fractures of the proximal femur (intracapsular as well as trochanteric frac tures) are the most devastating complication of osteoporosis. These fractur es are not only associated with significant morbidity, but also with a seve re risk of death (+/- 25%) within one year. The strongest predisposing fact or for fractures of the proximal femur is low bone density. In addition, nu merous studies provide evidence that several other factors, independently, contribute to hip fracture risk, including low body mass index, previous fr actures, muscle weakness, impaired vision, cognitive impairment, history of hyperthyroidism, use of long-acting sedatives, and physical inactivity. Th ese findings indicate the need for preventive strategies based on risk fact or modification and also on measures to maintain bone density. In view of t he growing incidence of subsequent fracture of the contralateral hip, preve ntive strategies should be initiated in all these patients as an integral p art of the postsurgical management during the acute hospital stay. These st rategies should not only include combined supplements of calcium and vitami n D to attenuate further bone loss, but also a comprehensive assessment of risk factors.