Hip Fracture

Hip fracture is one of the most dreaded hazards associated with aging. Its incidence rises exponentially so that 90% of such fractures occur after age 70.(39) It is estimated that 30% of older adults will have experienced a hip fracture by age 90.With the aging of the population, the prevalence of hip fracture will be increasing with its attendant increase in disability and mortality of the affected population. Unlike the more common osteoporotic compression fractures of the spine, hip fracture is associated with a loss of independence in mobility and is a common cause of institutionalization. Among women suffering a hip fracture, 15% to 25% will lose their independence in the first year after the fracture.(38) Although mortality associated with this fracture has been dramatically reduced over the past several decades by improved surgical procedures, excess mortality is still between 7% and 20%.(39) At age 50, a woman's chance of dying of a hip fracture is the same as her chance of dying of breast cancer.(58) For those who survive, the economic burden of rehabilitation and extended care is of increasing concern as healthcare providers attempt to control healthcare costs. Furthermore, there is some concern that the age-specific incidence of hip fracture may also be increasing,(101,113) although more recent reports suggest that this may no longer be the case in the United States or Scandinavia.(68) In this article, the authors explore the pathogenesis of this age-related condition and the promising strategies that have been developed to improve management of the patient with hip fracture and to prevent its occurrence.