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Essay on Hip Fracture Case Study
This short review focuses on hip fracture and its assessment, since for the patient it carries the most serious clinical consequences of all fractures and is associated with the major economic burden on the health care system.
- Hip fracture is related to a high degree of both morbidity and mortality, particularly for the elderly patient.
- Complications may arise from the fracture itself and the resulting surgical management and co morbidity. Only a small proportion of patients retain their previous mobility, while about 20% will require nursing home care.
- Mortality is also significant, estimates of 12 to 40% at one year having been reported from different populations and countries.
- Hip fracture however is also related to both bone strength and mechanical stress placed on the bone.
- In the majority of cases hip fracture typically results from a fall. Since most elderly subjects are osteopenic, the likelihood of falling with age becomes an important risk factor.
- It has been proposed that the incidence of hip fracture is 85% explained by underlying bone mass and 15% by age.
Since Laboratory measurement of BMD provides the most accurate assessment of actual bone mass, this value may be used to provide a prediction of future hip fracture, exactly as plasma cholesterol concentration is now used to indicate a risk of future cardiovascular disease (Baron, Lu-Yao, Barrett, McLerran, Fisher, 1994).
- Studies have established that bone density at the actual femoral neck is the best predictor of hip fracture, in comparison to measurements at the wrist, spine or calcaneus.
- It has been estimated that for each standard deviation (SD) decrease in BMD at the femoral neck there is a 2.6-fold increase in risk of hip fracture.
This means that a woman classified as osteoporotic (greater than 2.5 SD below her mean for age) is 28.3 times more likely to have a hip fracture than a woman whose density is 1 SD above the mean....
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