Environmental hazards and hip fractures. Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. Case-control study of hazards in the home and risk of falls and hip fractures. Hip fractures. Epidemiology, risk factors, falls, energy absorption, hip protectors, and prevention. Fractures of the hip: does the type of fall really affect the site of fracture? Risk Factors for Hip Fracture in Men from Southern Europe: The MEDOS Study
 Circumstances of Falls Causing Hip Fractures in the Elderly Identification of high-risk individuals for hip fracture: a 14-year prospective study. Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank The association between physical activity in different domains of life and risk of osteoporotic fractures. Risk factors for hip fracture in a high incidence area: A case-control study from Oslo, Norway A randomized clinical trial of the effectiveness of a discharge planning intervention in hospitalized elders with hip fracture due to falling. Risk of hip fractures in soft protected, hard protected, and unprotected falls A cluster randomised controlled trial to prevent injury due to falls in a residential aged care population. Quality of life related to fear of falling and hip fracture in older women: a time trade off study. Death, debility, and destitution following hip fracture. Risk factors for hip fracture in white men: the NHANES I Epidemiologic Follow-up Study.
The type of environmental hazards implicated in the aetiology of a consecutive series of 787 hip-fracture patients was prospect ively studied . Most falls occurred between 09 h 00 and midday and there was no seasonal variation . Fifty-one different environmental hazards were implicated in the aetiology of the fall for 58 % of patients . The nature of environmental hazards was diverse , implying that measures to reduce the risk of falls due to these factors are unlikely to lead to a significant reduction in the incidence of hip fractures OBJECTIVE To determine the relative importance of fall characteristics , body habitus , and femoral bone mineral density ( BMD ) in predicting hip fracture in community-dwelling elderly . DESIGN Prospect i ve case-control study . SETTING Community-based academic hospital . PARTICIPANTS A total of 149 ambulatory , community-dwelling fallers ( 126 women , 23 men ) aged 65 years and older , including 72 case patients ( fallers with hip fracture ) and 77 control fallers ( fallers with no hip fracture ) . MAIN OUTCOME MEASURES Fall characteristics , body habitus , femoral BMD . RESULTS Significant and independent risk factors for hip fracture in both sexes were direction of the fall ( adjusted odds ratio [ OR ] , 5.7 ; 95 % confidence interval [ CI ] , 2.3 to 14.0 ; P < .001 ) ; femoral neck BMD ( a decrease of 1 SD ; adjusted OR , 2.7 ; 95 % CI , 1.6 to 4.6 ; P < .001 ) ; potential energy of the fall ( an increase of 1 SD ; adjusted OR , 2.8 ; 95 % CI , 1.5 to 5.2 ; P < .001 ) ; and body mass index ( a decrease of 1 SD ; adjusted OR , 2.2 ; 95 % CI , 1.2 to 3.8 ; P < .01 ) . Importantly , the OR for the fall direction was unaffected by the addition or removal of BMD from the model . CONCLUSIONS We conclude that among elderly fallers -- in most of whom hip BMD is already less than the fracture threshold -- fall characteristics and body habitus are important risk factors for hip fracture and touch on a domain entirely missed by knowledge of BMD . These data suggest new targets for preventive therapy . In addition to the maintenance of bone density , reductions in fall severity ( eg , by use of trochanteric padding or enhancement of muscle strength ) may provide additional strategies for prevention of hip fracture in this age group The importance of environmental hazards in the home as risk factors for falls and fractures is uncertain . A case-control study was conducted , involving people aged 65 years and over referred to an occupational therapy department for home assessment . There were 52 subjects with a recent hip fracture , 43 fallers ( subjects with two or more falls in the past year but no hip fracture ) , and 157 non-fallers ( subjects without hip fracture and with fewer than two falls in the past year ) . Subjects ' homes were assessed for environmental hazards by occupational therapists using a  structured home assessment form comprising 35 potential hazards . Overall , the homes of fallers were no more hazardous than the homes of non-fallers . However , fallers with cognitive impairment had significantly more hazards in their homes than non-fallers with cognitive impairment . A wide range of environmental hazards was associated with hip fractures . Many of the findings of this study could be due to bias inherent in the case-control design . To overcome the inadequacies of observational studies for the investigation of home hazards and falls , r and omized trials are recommended to determine if removing hazards reduces the risk of falls and fractures The present review summarizes the pathogenic mechanisms leading to  hip fracture based on epidemiological , experimental , and controlled studies . The estimated lifetime risk of hip fracture is about 14 % in postmenopausal women and 6 % in men . The incidence of hip fractures increases exponentially with aging , but the time-trend in increasing age-specific incidence may not be a universal phenomenon . Postmenopausal women suffering earlier non-hip fractures have an increased risk of later hip fracture . The relative risk being highest within the first years following the fracture . Nursing home residents have a high risk of  hip fracture ( annual rate of 5 - 6 % ) , and the incidence of falls is about 1,500 falls/1,000 persons/year . Most hip fractures are a result of a direct trauma against the hip . The incidence of falls on the hip among nursing home residents is about 290 falls/1,000 persons/year and about 24 % of these impacts lead to hip fracture . The force acting on the hip may reach 3.7 kN in falls on the hip from st and ing height , which means that only susceptible subjects will sustain a hip fracture in such falls . The effective load acting on the hip is 35 % of the body weight in unprotected falls on the hip . Women with hip fractures have a lower body weight compared with controls , and they may also have less soft tissue covering the hip even when adjusted for body mass index , indicating a more and roid body habitus . Experimental studies show that the passive energy absorption in soft tissue covering the hip may influence the risk of hip fracture , and being an important determinant for the development of hip fracture , maybe more important than bone strength . External hip protectors were developed and tested in an open r and omised nursing home study . The rate of hip fractures was reduced by 50 % , corresponding to 9 out of 247 residents saved from sustaining a hip fracture . The review points to the essentials of the development of hip fracture , which constitutes ; risk of fall , type of fall , type of impact , energy absorption , and lastly bone strength , which is the ultimate and last permissive factor in the cascade leading to hip fracture . Risk estimation and prevention of hip fractures may prove realistic when these issues are taken into consideration The purpose of this study was to test accepted theories relating the characteristics of a fall to the anatomical site of hip fracture in the elderly . Twisting injuries are said to result in intracapsular fractures and falls directly onto the side are said to result in extracapsular fractures . 618 consecutive patients with a hip fracture were studied prospect ively by being question ed with regard to the nature of their fall . After exclusions , 552 patients were left in the study . Of these , 324 patients sustained intracapsular fractures and 228 extracapsular fractures . More intracapsular fractures were associated with a fall onto the affected side than extracapsular fractures and rotation at the hip during the fall had a significant association with extracapsular fractures . In this study 84 per cent of all fractures occurred by falling directly onto the affected side . The clinical significance of this finding is that protective padding on the hip might be beneficial Abstract : The aims of this study were to identify risk factors for  hip fracture in men aged 50 years or more . We identified 730 men with hip fracture from 14 centers from Portugal , Spain , France , Italy , Greece and Turkey during the course of a prospect i ve study of hip fracture incidence and 1132 age-stratified controls selected from the neighborhood or population registers . The question naire examined aspects of work , physical activity past and present , diseases and drugs , height , weight , indices of co-morbidity and consumption of tobacco , alcohol , calcium , coffee and tea . Significant risk factors identified by univariate analysis included low body mass index ( BMI ) , low sunlight exposure , a low degree of recreational physical activity , low consumption of milk and cheese , and a poor mental score . Co-morbidity including sleep disturbances , loss of weight , impaired mental status and poor appetite were also significant risk factors . Previous stroke with hemiplegia , prior fragility fractures , senile dementia , alcoholism and gastrectomy were associated with significant risk , whereas osteoarthrosis , nephrolithiasis and myocardial infa rct ion were associated with lower risks . Taking medications was not associated with a difference in risk apart from a protective effect with the use of analgesics independent of co-existing osteoarthrosis and an increased risk with the use of anti-epileptic agents . Of the potentially ‘ reversible ’ risk factors , BMI , leisure exercise , exposure to sunlight and consumption of tea and alcohol and tobacco remained independent risk factors after multivariate analysis , accounting for 54 % of hip fractures . Excluding BMI , 46 % of fractures could be explained on the basis of the risk factors sought . Of the remaining factors low exposure to sunlight and decreased physical activity accounted for the highest attributable risks ( 14 % and 9 % respectively ) . The use of risk factors to predict hip fractures had relatively low sensitivity and specificity ( 59.6 % and 61.0 % respectively ) . We conclude that lifestyle factors are associated with significant differences in the risk of hip fracture . Potentially remediable factors including a low degree of physical exercise and a low BMI account for a large component of the total risk A prospect i ve analysis was performed on 832 patients to determine the circumstances surrounding falls leading to hip fracture within a homogenous , elderly urban population . Special emphasis was placed on the season of year , time of day , location of fall , and other circumstances in which the fracture occurred . All patients were community dwelling , cognitively intact , previously ambulatory elderly who sustained a femoral neck or intertrochanteric fracture . Most fractures occurred at home , particularly in patients who were older , less healthy , and poorer ambulators . More than 75 % of fractures result ed from a fall while the patient was st and ing or walking . Most falls occurred during daylight hours with a peak seen in the afternoon . No seasonal variation in the incidence of hip fractures was observed UNLABELLED In this 14-year prospect i ve study , men and women were found to share a common set of risk factors for hip fracture : low BMD , postural instability and /or quadriceps weakness , a history of falls , and prior fracture . The combination of these risk factors accounted for 57 % and 37 % of hip fractures in women and men , respectively . INTRODUCTION Risk factors for hip fracture , including low BMD , identified in women , have not been shown to be useful in men . It is also not known whether fall-related factors ( muscle strength and postural instability ) predict hip fracture . This study examined the association between falls-related  factors  and hip fractures in elderly men and women . MATERIAL S AND METHODS This is an epidemiologic , community-based prospect i ve study , which included 960 women and 689 men > or = 60 years of age who have been followed for a median of 12 years ( interquartile range , 6 - 13 ) . The number of person-years was 9961 for women and 4463 for men . The outcome measure was incidence of hip fracture . Risk factors were femoral neck BMD ( FNBMD ) , postural sway , quadriceps strength , prior fracture , and fall . RESULTS Between 1989 and 2003 , 115 ( 86 women ) sustained a hip fracture . The risk of hip fracture ( as measured by hazards ratio [ HR ] ) was increased by 3.6-fold ( 95 % CI : 2.6 - 4.5 ) in women and 3.4-fold ( 95 % CI : 2.5 - 4.6 ) in men for each SD ( 0.12 g/cm2 ) reduction in FNBMD . After adjusting for BMD , the risk of hip fracture was also increased in individuals with the highest tertile of postural sway ( HR : 2.7 ; 95 % CI : 1.6 - 4.5 ) and low tertiles of quadriceps strength ( HR : 3.0 ; 95 % CI : 1.3 - 6.8 ) . Furthermore , a history of fall during the preceding 12 months and a history of fracture were independent predictors of hip fracture . For each level of BMD , the risk of hip fracture increased linearly with the number of non-BMD risk factors . Approximately 57 % and 37 % of hip fracture cases in women and men , respectively , were attributable to the presence of risk factors , osteoporosis ( BMD T score < or = -2.5 ) , and advancing age . CONCLUSIONS Men and women had a common set of risk factors for hip fracture : low BMD , postural instability and /or quadriceps weakness , a history of falls , and prior fracture . Preventive strategies should simultaneously target reducing falls and improvement of bone strength in both men and women Study design Retrospective review of prospect ively collected data . Objective To describe the impact of patient demographics , injury-specific factors , and medical co-morbidities on outcomes after hip fracture using the National Sample Program ( NSP ) of the National Trauma Data Bank ( NTDB ) . Methods The 2008 NSP-NTDB was queried to identify patients sustaining hip fractures .  Patient demographics , co-morbidities , injury-specific factors , and outcomes ( including mortality and complications ) were recorded and a national estimate model was developed . Unadjusted differences for risk factors were evaluated using t test/Wald Chi square analyses . Weighted logistic regression and sensitivity analyses were performed to control for all factors in the model . Results The weighted sample contained 44,419 incidents of hip fracture . The average age was 72.7 . Sixty-two percent of the population was female and 80 % was white .  The mortality rate was 4.5 % and 12.5 % sustained at least one complication . Seventeen percent of patients who sustained at least one complication died  . Dialysis , presenting in shock , cardiac disease , male sex , and ISS were significant predictors of mortality , while dialysis , obesity , cardiac disease , diabetes , and a procedure delay of ≥2 days influenced complications . The major potential modifiable risk factor appears to be time to procedure , which had a significant impact on complications . Conclusions This is the first study to postulate predictors of morbidity and mortality  following hip fracture in a US national model . While many co-morbidities appear to be influential in predicting outcome , some of the more significant factors include the presence of shock , dialysis , obesity , and time to surgery . Level of evidence Prognostic study , Level II A large body of epidemiological evidence suggests an inverse relationship between  physical activity  and risk of fractures . However , it is unclear how this association varies according to the domain of life in which the activity is undertaken . In this analysis of the European Prospect i ve Investigation of Cancer-Norfolk study , we assessed total and domain-specific physical activity  using a vali date d question naire ( EPAQ2 ) in 14,903 participants ( 6514 men , mean age 62 year ) who also underwent quantitative ultrasound of the heel .  After a median follow-up of 7.5 years , there were 504 fractures of which 164 were hip fractures . In multivariable linear regression analysis , broadb and ultrasound attenuation ( BUA ) was positively associated with total and leisure-time activities while showing no association with transportation and work activities . Home activities were associated with a lower BUA  among younger participants . In multivariable Cox proportional-hazards models , moderate activities at home and in leisure time were associated with lower hip fracture risk among women ( hazard ratios [ HR ] 0.51 and 0.55 , p value 0.02 and 0.03 , respectively ) . Among men , leisure-time activities were associated with lower risk of hip fracture ( HR=0.58 ; p for trend<0.001 ) whereas activities at home were associated with higher risk of any fracture ( HR=1.25 ; p for trend=0.008 ) . Walking for leisure or transport was associated with lower risk of fracture in both men and women . Multivariable fractional polynomial modelling showed a U-shaped association between home activities and fracture risk especially among women . This study suggests that different domains of physical activity may relate differently to fracture risk and these relationships may vary by sex The aim of this population -based matched case-control study was to evaluate the effect of risk factors for hip fracture in Oslo , Norway , which has some of the highest incidence rates ever reported . The study population comprised all non-institutionalized persons 50 years or older living in the catchment area of two Oslo hospitals , and cases were 246 patients admitted for hip fracture during a 1-year period . The controls were r and omly selected from the study population , matched 1:1 for age and sex . Hip fracture was associated with lean body stature , smoking , low grip strength and decreased levels of physical activity , and inversely with length of education . In addition , hip fracture was inversely related to indicators of total food intake ( number of meals per day , frequency of dinners , and slices of bread per day ) . A relation between hip fracture and low vitamin D intake was also suggested , whereas no association with dietary calcium intake was found . Finally , increased risk of fracture was seen in persons reporting two or more hospital admissions in the previous 2 years , and in those reporting weight reduction due to poor appetite during the previous year . In conclusion , the risk factor pattern for hip fracture was much the same in the elderly population of Oslo as previously described in other population s with a lower incidence of fracture . This study also indicates a relation between hip fracture and low food intake AIM The objective of this study was to examine the effectiveness of a  discharge plan  in hospitalized elderly patients with hip fracture due to falling . BACKGROUND Hip fractures are an important cause of morbidity and mortality among older people . Hip fracture patients require ongoing medical and long-term care services . Discharge plan services can play a very important role for these patients , since the services improved their outcome conditions . METHODS Hip fracture patients aged 65 years and older ( n = 126 ) , hospitalized due to falling and discharged from a medical centre in northern Taiwan , were r and omly assigned to either a comparison group ( the routine care ) or experimental group ( the discharge planning intervention ) . The outcomes used to determine the effectiveness of the intervention were : length of hospitalized stay , rate of readmission , repeat falls and survival , and activities of daily living . RESULTS The discharge planning intervention  decreased length of stay , rate of readmission and rate of survival and improved activities of daily living for intervention group compared with those of control group . Mean total SF-36 scores of patients in the experimental group were higher than for the control group and both groups had improved quality of life . CONCLUSION The discharge planning benefited older people with hip fractures . RELEVANCE TO CLINICAL PRACTICE A discharge planning intervention by a nurse can improve physical outcomes and quality of life in hip fracture patients Objective : To compare hip fracture risk in soft and hard protected falls with the risk in unprotected falls and to compare the incidence of hip fractures in nursing homes providing soft and hard hip protectors .  Methods : An observational study conducted within the framework of a cluster r and omized trial in 18 nursing homes . Nursing homes were r and omized to offer either soft or hard hip protectors . Individual participants were followed for falls for 18 months . Results : Of 1236 participating residents , 607 suffered 2926 falls ; 590 of the 2926 falls were categorized as soft protected , 852 as hard protected , and 1388 as unprotected falls . Sixty-six verified hip fractures occurred : eight in soft protected falls , 11 in hard protected falls , and 45 in unprotected falls . The hip fracture risk in soft and hard protected falls was almost 60 % lower than in unprotected falls ( OR ( soft ) 0.36 , 95 % CI 0.17 to 0.77 ; OR ( hard ) 0.41 , 95 % CI 0.19 to 0.89 ) . The incidence of hip fracture was 4.6 and 6.2 per 100 person-years in nursing homes providing soft and hard hip protectors , respectively ( p = 0.212 ) . Conclusion : Both types of hip protector have the potential , when worn correctly , to reduce the risk of a hip fracture in falls by nearly 60 % . Both can be recommended to nursing-home residents as a means of preventing hip fractures OBJECTIVE To test the effectiveness of using a full-time project nurse to assist residential aged care facilities in using evidence -based approaches to falls injury prevention . DESIGN , SETTING AND PARTICIPANTS Cluster r and omised controlled trial involving 5391 residents in 88 aged care facilities in the Hunter and Lower Mid North Coast areas of New South Wales . Residents were followed for 545 days or until death or discharge . Data were collected from July 2005 to June 2007 . INTERVENTION Employment of a project nurse to encourage best- practice falls injury prevention strategies during the 17-month intervention period . MAIN OUTCOME MEASURES Monthly data about falls , falls injury and falls injury prevention programs ; audit of hospitalisation for fractured neck of femur . RESULTS Despite significant increases in the provision of hip protectors and use of vitamin D supplementation in both intervention and control facilities , there was no difference in the number of falls or falls injuries between the intervention and control groups , nor a reduction in falls overall . There was also no difference between the 7-month pre-intervention period and the intervention period in the number of falls or falls injuries . Factors related to residents having an increased risk of falls with fractured neck of femur included being ambulant , having dementia , increasing age , and having a high falls risk assessment score . CONCLUSION It is difficult to change falls risk among high-risk population s , including people with dementia . The use of important strategies such as hip protectors and vitamin D and calcium supplementation increased during the study , probably with contamination of control facilities . Longer follow-up may be required to measure the impact on falls outcomes of the strategy of using a facilitating nurse . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry ACTRN12605000540617 OBJECTIVE To estimate the utility ( preference for health ) associated with hip fracture and fear of falling among older women . DESIGN Quality of life survey with the time trade off technique . The technique derives an estimate of preference for health states by finding the point at which respondents show no preference between a longer but lower quality of life and a shorter time in full health . SETTING A r and omised trial of external hip protectors for older women at risk of hip fracture . PARTICIPANTS 194 women aged > /= 75 years enrolled in the r and omised controlled trial or who were eligible for the trial but refused completed a quality of life interview face to face . OUTCOME MEASURES Respondents were asked to rate their own health by using the Euroqol instrument and then rate three health states ( fear of falling , a " good " hip fracture , and a " bad " hip fracture ) by using time trade off technique . RESULTS On an interval scale between 0 ( death ) and 1 ( full health ) , a " bad " hip fracture ( which results in admission to a nursing home ) was valued at 0.05 ; a " good " hip fracture ( maintaining independent living in the community ) 0.31 , and fear of falling 0.67 . Of women surveyed , 80 % would rather be dead ( utility=0 ) than experience the loss of independence and quality of life that results from a bad hip fracture and subsequent admission to a nursing home . The differences in mean utility weights between the trial groups and the refusers were not significant . A test-retest study on 36 women found that the results were reliable with correlation coefficients within classes ranging from 0.61 to 0.88 . CONCLUSIONS Among older women who have exceeded average life expectancy , quality of life is profoundly threatened by falls and hip fractures . Older women place a very high marginal value on their health . Any loss of ability to live independently in the community has a considerable detrimental effect on their quality of life BACKGROUND We examined the effects of  hip fracture  on mortality , entry into long-term institutional care , and new evidence of poverty . We estimate of the proportion of hip fracture patients who require not just short-term rehabilitation but who become dependent on long-term institutional care , and the risk of becoming newly dependent on Medicaid or eligible for low-income subsidies following hip fracture . METHODS We used data from 2005 through 2010 for a r and om 5 % sample of Medicare beneficiaries ( N = 3.1 million ) to conduct a retrospective matched cohort study . We used high-dimensional propensity score matching to compare outcomes for patients who experienced a hip fracture with subjects who did not , but had similar propensity for suffering a hip fracture . We then compared the 1-year risk of death , debility , and destitution between groups . RESULTS We matched 43,210 hip fracture patients to comparators without a hip fracture . Hip fractures were associated with more than a twofold increase in likelihood of mortality ( incidence proportion ratio [ IPR ] of 2.27 , 95 % CI , 2.20 - 2.34 ) , a fourfold increase in likelihood of requiring long-term nursing facility care ( IPR , 3.96 ; 95 % CI , 3.77 - 4.16 ) , and a twofold increase in the probability of entering into low-income status ( IPR , 2.14 ; 95 % CI 1.99 - 2.31 ) within 1 year following hip fracture compared with subjects without a hip fracture . CONCLUSIONS Hip fracture in elderly patients result ed in increased death , debility , and destitution . Initiatives that lead to improved treatment of osteoporosis could result in a decrease in incidence of fractures , subsequent death , debility , and destitution for older adults This prospect i ve population -based study assessed predictors of hip fracture risk in white men . Participants were members of the Epidemiologic Follow-up Study cohort of the First National Health and Nutrition Examination Survey , a nationally representative sample of noninstitutionalized civilians who were followed for a maximum of 22 years . A cohort of 2879 white men ( 2249 in the nutrition and weight-loss sub sample , 1437 in the bone density sub sample ) aged 45 - 74 years at baseline ( 1971 - 1975 ) were observed through 1992 . Ninety-four percent of the original cohort were successfully traced . Hospital records and death certificates were used to identify a total of 71 hip fracture cases ( 61 in the nutrition and weight-loss sub sample , 26 in the bone-density sub sample ) . Among the factors evaluated were age at baseline , previous fractures other than hip , body mass index , smoking status , alcohol consumption , nonrecreational physical activity , weight loss from maximum , calcium intake , number of calories , protein consumption , chronic disease prevalence , and phalangeal bone density . The risk adjusted relative risk ( RR ) of hip fracture was significantly associated with presence of one or more chronic conditions ( RR = 1.91 , 95 % confidence interval [ CI ] = 1.19 - 3.06 ) , weight loss from maximum > or = 10 % ( RR = 2.27 , 95 % CI 1.13 - 4.59 ) , and 1 SD change in phalangeal bone density ( RR = 1.73 , 95 % CI 1.11 - 2.68 ) . No other variables were significantly related to hip fracture risk . Although based on a small number of cases , this is one of the first prospect i ve studies to relate weight loss and bone density to hip fracture risk in men
Ranging from the lower ambient temperature , the presence of snow cover , seasonal factors , and time of the day to location of fall , these factors have different levels of impact related to higher incidence or mortality of fall .
There existed systematic review on studies investigating the association between hip fractures and external risk factors including meteorological factors .
Albeit the fact that most serious common fall injury is a hip fracture , it can not account for all injuries forms of fall .
There was a lack of systematic review covering all fall-related injury or deaths to thoroughly summarise meteorological aspects of fall .
This study aim ed to systematic ally review epidemiological studies of fall and fall-related circumstances without restriction to hip fracture .