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Impact near the hip dominates fracture risk in elderly nursing home residents who fall

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Summary

Hip fractures among the elderly are a significant and rapidly growing public health problem. The prevailing view is that most hip fractures are the consequence of age-related bone loss or osteoporosis. However, because over 90% of hip fractures are the result of falls, we have undertaken a falls surveillance study to determine if factors related to the mechanics of falling are associated with increased risk of hip fracture. Case subjects with hip fracture and control subjects without hip fracture were sampled from falls recorded at the Hebrew Rehabilitation Center for Aged, a chronic care facility. Fall information was obtained by interview of the subject and witnesses if the fall was witnessed. Data were analyzed by multiple logistic regression. Increased risk of hip fracture from a fall was associated with impacting on the hip or side of the leg and potential energy associated with the fall. Quetelet, or body mass index, was inversely related to fracture risk. The adjusted odds ratio of hip fracture for a fall involving impact on the hip region was 21.7 (95% confidence interval, 8.2–58). The potential energy associated with these falls was an order of magnitude greater than the average energy required to fracture elderly, cadaveric, proximal femurs in earlier in vitro experiments. We conclude, therefore, that a fall from standing height should no longer be considered minimal trauma but rather trauma of sufficient magnitude to pose a high risk of hip fracture if impact occurs on the hip and if energy-absorbing processes are inadequate. These new findings suggest that fall mechanics play an important role in the etiology of hip fracture among the elderly.

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References

  1. Holbrook TL, Grazier K, Kelsey JL, Stauffer RN (1984) The frequency of occurrence, impact, and cost of selected musculoskeletal conditions in the United States. In: American Academy of Orthopaedic Surgeons

  2. Phillips S, Fox N, Jacobs J, Wright W (1988) The direct medical costs of osteoporosis for American women aged 45 and older. Bone 9:271–279

    Google Scholar 

  3. Melton LJ III (1988) Epidemiology of fractures. In: Riggs BL, Melton III LJ (eds) Osteoporosis: etiology, diagnosis, and management, Raven Press, New York, pp 133–154

    Google Scholar 

  4. Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ (1985) Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 7:178–208

    Google Scholar 

  5. Cummings SR (1987) Epidemiology of hip fractures. In: Jensen J, Riis B, Christiansen C (eds) Osteoporosis. Proc Intl Symp Osteop Norhaven A/S, Viborg Denmark, pp 40–43

  6. Kelsey JL, Hoffman S (1987) Risk factors for hip fracture. N Engl J Med 316:404–406

    Google Scholar 

  7. Farmer ME, White LR, Brody JA, Baily KR (1984) Race and sex differences in hip fracture incidence. Am J Pub Health 74: 1374–1380

    Google Scholar 

  8. Cummings SR (1985) Are patients with hip fractures more osteoporotic? Am J Med 78:487–493

    Google Scholar 

  9. Melton LJ III, Eddy DM, Johnston CC Jr (1990) Screening for osteoporosis. Ann Int Med 112:516–528

    Google Scholar 

  10. Resnick NM, Greenspan SL (1989) “Senile” osteoporosis reconsidered. JAMA 261:1025–1029

    Google Scholar 

  11. Kiel DP, Felson DT, Anderson JJ, et al. (1987) Hip fracture and the use of estrogens in postmenopausal women: the Framingham Study. N Engl J Med 317:1169–1174

    Google Scholar 

  12. Lindsay R, Tohme JF (1990) Estrogen treatment of patients with established postmenopausal osteoporosis. Ob Gyn 76:290–295

    Google Scholar 

  13. Quigley MET, Martin PL, Burnier et al. (1987) Estrogen therapy arrests bone loss in elderly women. Am J Ob Gyn 156:1516–1523

    Google Scholar 

  14. Jensen GF, Christiansen C, Transbol I (1982) Treatment of postmenopausal osteoporosis. A controlled therapeutic trial comparing oestrogen/gestagen, 1,25-dihydroxy-vitamin D3 and calcium. Clin Endocrinol 16:515–524

    Google Scholar 

  15. Alffram PA (1964) An epidemiologic study of cervical and trochanteric fracture of the femur in an urban population. Acta Orthop Scand (suppl) 65

  16. Waller JA (1978) Falls among the elderly—human and environmental factors. Accid Anal Prev 10:21–33

    Google Scholar 

  17. Melton LJ, Chao EYS, Lane J (1988) Biomechanical aspects of fractures. In: Riggs BL, Melton LJ (eds) Osteoporosis: etiology, diagnosis and management. Raven Press, New York, pp 111–131

    Google Scholar 

  18. Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O'Brien LA, Hoffman S, Kaplan F (1991) Risk factors for falls as a cause of hip fracture in women. N Engl J Med 324:1326–1331

    Google Scholar 

  19. Hedlund R, Lindgren U (1987) Trauma type, age and gender as determinants of hip fracture. J Orthop Res 5:242–246

    Google Scholar 

  20. Cummings SR, Rubin SM, Black D (1990) The future of hip fractures in the United States: numbers, costs, and potential effects of postmenopausal estrogen. 252:163–166

    Google Scholar 

  21. Cummings SR, Black DM, Nevitt MC, Browner WS, Cauley JA, Genant HK, Mascioli SR, Scott JC (1990) Appendicular bone density and age predict hip fracture in women. JAMA 263:665–668

    Google Scholar 

  22. Gryfe CI, Amies A, Ashley MJ (1977) A longitudinal study of falls in an elderly population: I. Incidence and morbidity. Age Aging 6:201

    Google Scholar 

  23. Nevitt MC, Cummings SR, Kidd S, Black D (1989) Risk factors for recurrent nonsyncopal falls: a prospective study. JAMA 261:2663–2668

    Google Scholar 

  24. Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Eng J Med 319:1701–1707

    Google Scholar 

  25. Hindmarsh JJ, Estes EH (1989) Falls in older persons: causes and interventions. Arch Intern Med 149:2217–2222

    Google Scholar 

  26. Hornbrook MC, Wingfield DJ, Stevens VJ, et al (1987) Preventing falls among the noninstitutionalized elderly: strategy for assessing outcomes of a randomized trial. Ann Meeting Am Pub Health Assoc October, 1987

  27. Campbell AJ, Borrie MJ, Spears GF (1989) Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontology 44:112–117

    Google Scholar 

  28. DeVito CA, Lambert DA, Sattin RW, Bacchelli S, Ros A, Rodriquez JG (1988) Fall injuries among the elderly: community-based surveillance. J Am Geriatr Soc 36:1029–1035

    Google Scholar 

  29. Lipsitz LA, Jonsson PV, Kelly MM, Koestner JS (1991) Causes and correlates of recurrent falls in ambulatory frail elderly. J Gerontol 46:M114-M122

    Google Scholar 

  30. Prudham D, Evans JG (1981) Factors associated with falls in the elderly: a community study. Age Aging 10:141–146

    Google Scholar 

  31. Ray WA, Griffin MR, Schaffner W, Baugh DK, Melton LJ III (1987) Psychotropic drug use and the risk of hip fracture. N Engl J Med 316:363–369

    Google Scholar 

  32. Robbins AS, Rubenstein LZ, Josephson KR, Schulman BL, Osterweil D, Fine G (1989) Predictors of falls among elderly people. Arch Intern Med 149:1628–1633

    Google Scholar 

  33. Cummings SR, Nevitt MC (1989) A hypothesis: the causes of hip fracture. J Gerontol 44:M107-M111

    Google Scholar 

  34. Frankel VH, Burstein AH (1970) Orthopaedic biomechanics. Lea & Febiger, Philadelphia

    Google Scholar 

  35. Muckle DS, Bentley G, Deane G, Kemp FH (1978) Basic science of the hip. In: Muckle DS (ed) Femoral neck fractures and hip joint injuries. John Wiley and Sons, New York, pp 1–54

    Google Scholar 

  36. Besdine RW (1983) The educational utility of comprehensive functional assessment in the elderly. J Am Geriatr Soc 31:651–656

    Google Scholar 

  37. Khodadadeh S, Whittle MW, Bremble GR (1986) Height of center of body mass during osteoarthritic gait. Clin Biomech 1:77–80

    Google Scholar 

  38. Nevitt MC, Cummings SR, Harvey S, Seeley DG (in press): Type of fall and risk of hip and wrist fractures. J Gerontol Soc

  39. Garrow JS, Webster J (1985) Quetelet's index (W/H2) as a measure of fatness. Int J Obes 9:147–153

    Google Scholar 

  40. Pruzansky ME, Turano M, Luckey M, Senie R (1989) Low body weight as a risk factor for hip fracture in both black and white women. J Orthop Res 7:192–197

    Google Scholar 

  41. Cooper C, Barker DJP, Wickham C (1988) Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain. Br Med J 297:1443–1446

    Google Scholar 

  42. Hemenway D, Colditz GA (1990) The effect of climate on fractures and deaths due to falls among white women. Accid Anal Prev 22:59–65

    Google Scholar 

  43. Williams AR, Weiss NS, Ure CL, Ballard J, Daling JR (1982) Effect of weight, smoking and estrogen use on the risk of hip and forearm fractures in postmenopausal women. Obstet Gynecol 60:695–699

    Google Scholar 

  44. Farmer ME, Harris T, Madans JH, Wallace RB, Coroni-Huntley J, White LR (1989) Anthropometric indicators and hip fracture: the NHANES I epidemiologic follow-up study. JAGS 37:9–16

    Google Scholar 

  45. Heidrich FE, Stergachis A, Gross KM (1991) Diuretic drug use and the risk for hip fracture. Ann Int Med 115:1–65

    Google Scholar 

  46. Paganini-Hill A, Ross RK, Henderson BE (1991) Exercise and other factors in the prevention of hip fracture: the leisure world study. Epidemiology 2:16–25

    Google Scholar 

  47. Lindsay R, Cosman F, Herrington BS, Himmelstein S (1992) Bone mass and body composition in normal women. J Bone Miner Res 7:55–63

    Google Scholar 

  48. Mazess RB, Barden HS, Drinka PJ, Bauwens SF, Orwoll ES, Bell NH (1990) Influence of age and body weight on spine and femur bone mineral density in US white men. J Bone Miner Res 5:645–652

    Google Scholar 

  49. Reid IR, Ames R, Evans MC, Sharpe S, Gamble G, France JT, Lim TMT, Cundy TF (1992) Determinants of total body and regional bone mineral density in normal postmenopausal women: a key role for fat mass. J Clin Endocrinol Metab 75: 45–51

    Google Scholar 

  50. Lotz JC, Hayes WC (1990) Estimates of hip fracture risk from falls using quantitative computed tomography. J Bone Joint Surg [Am] 72:689–700

    Google Scholar 

  51. Cummings SR, Nevitt MC, Kidd S (1988) Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc 36(7):613–616

    Google Scholar 

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Hayes, W.C., Myers, E.R., Morris, J.N. et al. Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int 52, 192–198 (1993). https://doi.org/10.1007/BF00298717

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  • DOI: https://doi.org/10.1007/BF00298717

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