Older patients will make lifestyle changes to avoid fractures, study finds

Older patients who know they are at risk of fractures will make positive lifestyle changes to avoid them, such as exercising, wearing proper footwear and taking supplements, a new study has found.

The findings are important because much previous research in bone health has focused on medications or found that people make negative lifestyle changes such as reducing housework or leisure activities because they are afraid of falling, said

Dr. Joanna Sale, a researcher at St. Michael's Hospital and lead author of the study.

Half of all women over the age of 50 and one in five men over 50 will have a fracture after falling from standing height or lower. Having one such fracture doubles a person's risk of having another.

Dr. Sale, a clinical epidemiologist, said her research was aimed at finding ways to prevent those repeat fractures, particularly hip fractures, because about half of all hip fracture patients die or end up in long-term care facilities.

Dr. Sale's study, published online in the prestigious journal Osteoporosis International, looked at patients over 65 who participated in the Osteoporosis Exemplary Care Program at St. Michael's Fracture Clinic. Research participants were interviewed about their perceived fracture risk, recommendations they received about their bone health, results of bone density tests and any lifestyle or behavioural changes they made since their last fracture.

All but one participant appeared to understand they had low bone mass and were at risk of a future fracture, but many were confused about the significance of bone density.

Many said they didn't want to think about the possibility of a future fracture and felt they had little control over risk factors such as age – yet they all engaged in a number of daily behavioural strategies to manage their fracture risk. Most were concerned about being careful, such as using handrails or wearing proper shoes.

As the elderly population grows, the number of hip fractures continues to increase. The elderly have weaker bone and are more likely to fall due to poorer balance, medication side effects, and difficulty maneuvering around environmental hazards. Clinicians in many fields are involved in caring for patients with hip fractures and should be familiar with the basic assessment and management of these injuries.

This topic review will discuss the major types of hip fractures, including basic anatomy, fracture classification, and clinical and radiographic assessment. The details of surgical treatment are beyond the scope of this review. Prevention of hip fractures, preoperative assessment and the prevention and management of common medical complications associated with hip fractures are all discussed separately.

Worldwide, the total number of hip fractures is expected to surpass 6 million by the year 2050. A total of 310,000 individuals were hospitalized with hip fractures in the United States (US) alone in 2003, according to data from the US Agency for Healthcare Research and Quality, accounting for 30 percent of all hospitalized patients. Approximately one-third (101,800) of fracture patients went on to receive a hip replacement. The estimated cost for treatment is approximately $10.3 to 15.2 billion a year in the US.