Asymmetric vestibular function in the elderly might be a significant contributor to hip fractures

The aim of this study was to assess postural control, vestibular symmetry a nd health status in otherwise healthy hip fracture subjects and compare the se factors with controls. The fracture subjects were recruited from 113 con secutive patients operated 12-33 months earlier. Nineteen of those were oth erwise healthy and fulfilled the inclusion criteria, They were assessed and compared with 28 age- and sex-matched controls. Nystagmus after head shake was checked for by video-nystagmoscopy (charged couple device cameras). Vi bration sensation was tested with a tuning fork, medical history and postur ography of vibration-induced sway were studied. The subjects had a signific antly higher frequency of head shake nystagmus (p = 0.03), indicating a ves tibular asymmetry and a history of previous fractures (p = 0.002), Nine out of 12 subjects had fallen and sustained the hip fracture towards the slow phase of the nystagmus, which is expected in a vestibular related fall. Los ing balance during testing was more frequent among the subjects than among the controls (p = 0.002), The subjects with head shake nystagmus swayed mor e than those without, especially in the sagittal plane during neck vibratio n with eyes closed (p < 0.001), Vibration perception was significantly poor er in the operated legs than in the healthy legs (p = 0.021) and in the leg s of the controls (p = 0.001). The findings suggest that vestibular asymmet ries may contribute to falls and fractures in elderly people. As such asymm etries can be compensated to a certain degree by specific training programs , these might be advisable for elderly people, especially those with a hist ory of falls or fractures or where a vestibular asymmetry is suspected.