Hip fractures. An epidemiological review.

A computerized literature search was performed to identify articles on the epidemiology of hip fractures. Information from a total of 56 papers was gathered, mainly from developed Western countries. Inclusion criteria were the method of randomization, sample size, and relevance for the topic. As the proportion of elderly in the general population has increased, the incidence of hip fractures has risen. Mortality is high: a third of patients do not survive beyond one year after fracturing their hip. There are two main determinants for hip fractures: falls and increased bone fragility. The most important risk factors identified are neuromuscular and visual impairment, pre-existing medical conditions, dementia, low bone density, alcohol intake, smoking, and immobilization. Also, thinner people are at higher risk because of the reduced energy dissipation following a fall. There is a significantly higher risk for institutionalized patients. Primary prevention focuses on eliminating the two main determinants by decreasing falls and their effects, by strengthening the bone either through elimination of risk factors or through medication. Surgical management and early rehabilitation should be favored. Prevention has been shown to be the single most important factor to slow down the increasing incidence of such fractures. More research into prevention is required.