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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.

Hip fractures are recognized to be a major public health problem in many Western nations, most notably those in North America, Europe and Oceania. Incidence rates for hip fracture following afall in other parts of the world are generally lower than those reported for these predominantly Caucasian populations, and this has led to the belief that osteoporosis represents less of a problem to the nations of Asia, South American and Africa. Preventing falls and fall prevention monitors or alarms are an important toll in the fight against falls. Demographic changes in the next 60 years, however, will lead to huge increases in the elderly populations of those countries. We have applied available incidence rates for hip fracture from various parts of the world to projected populations in 1990, 2025 and 2050 in order to estimate the numbers of hip fractures which might occur in each of the major continental regions. The projections indicate that the number of hip fractures occurring in the world each year will rise from 1.66 million in 1990 to 6.26 million by 2050. While Europe and North America account for about half of all hip fractures among elderly people today, this proportion will fall to around one quarter in 2050, by which time steep increases will be observed throughout Asia and Latin America. The results suggest that osteoporosis will truly become a global problem over the next half century, and that preventive strategies will be required in parts of the world where they are not currently felt to be necessary.

Diagram of a hip facture due to osteoporosis

Hip fractures in the elderly are common. In fact, for every 10 hip fractures, about nine occur in people over the age of 60. "Hip fractures double with every five-year increase in age after age 50," says Sandy B. Ganz, PT, DSc, GCS, the director of rehabilitation at Amsterdam Nursing Home in New York City. By 90 years of age, one in four women and one in eight men will have fractured a hip, according to a study done by the Center for Disease Control and Prevention.

The risk factors for suffering a broken hip are numerous, including:

  • Osteoporosis: This disease causes bones to become weaker, making them more susceptible to fracture. In the U.S., an estimated 10 million individuals already have osteoporosis, and 80% of those affected are women. In this population, hip fractures can occur during simple weight-bearing activities.

  • Gender: Women lose bone density more quickly than men due to a decrease in estrogen levels after menopause begins.

  • Heredity: Small-boned, slender-framed people; Caucasians; and Asians have an increased risk of suffering from osteoporosis.

  • Nutrition: Poor nutrition in childhood increases hip-fracture risk. Eating disorders such as anorexia nervosa and bulimia damage bones.

  • Tobacco and alcohol use: Smoking and drinking too much can lead to bone loss.

  • Medications: Taking four or more medications at a time or taking any psychoactive medications are risk factors for falling.

  • Home environment: Throw rugs and electrical wires are tripping hazards, as are a lack of stair railings and grab bars, unstable furniture, and poor lighting.

  • Medical conditions: The following conditions can increase the risk of hip fractures, either through bone loss or by increasing the risk of falling: endocrine disorders, such as type 1 diabetes; gastrointestinal disorders; rheumatoid disorders; prolonged bed rest or immobility; nervous system disorders such as Parkinson's disease or multiple sclerosisdementia; and depression.

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