A multidimensional intervention strategy to reduce hip fracture risk in the elderly: Isn't it time to act?

Abstract

For a 50-year-old caucasian woman today, the risk of a hip fracture over her remaining lifetime is about 17% (1). Tomorrow the situation will clearly be worse because the continual increase in life expectancy will cause a 3-fold rise in worldwide fracture incidence over the next 60 years, particularly in women, but also in men. In addition, a secular increase in the incidence of hip fractures in individuals of the same age has been noted in both sexes by several investigators, and the cost of hip fractures is expected to dramatically increase in the next decades (2). Consequently, preventive strategies are urgently required. In a milestone study by Meunier et al., substitution with vitamin D and calcium was found to substantially increase bone density of the hip in elderly ambulatory women living in nursing homes (3). More importantly, women who received cholecalciferol and calcium had 43% fewer hip fractures after 18 months of therapy. These strong findings must be tempered by the high dropout rates (30% withdrew for reasons other than death) and the lack of a factorial design that would allow the relative merits of each of the supplements to be determined. However, this study was the first to demonstrate a dramatic effect of a pharmacologic osteoporotic therapy on hip fracture incidence in the very elderly. Although similar results may not be obtained in community-based elderly people who are less likely to be severely deficient in vitamin D (4), this was the first report to provide evidence that it may never be too late to prevent hip fractures, even in the oldest old. In case of treatment of all women living in nursing homes, the economic and social savings might be very substantial. According to an estimation by Meunier, treating all institutionalized women in France would save approximately FF 150,000 000 ($ 35,000 000) per year, the economic balance of prevention becoming positive from the age of 73.5 years on.

DOI: 10.1007/BF02242448

Cite this paper

@article{Boonen1997AMI, title={A multidimensional intervention strategy to reduce hip fracture risk in the elderly: Isn't it time to act?}, author={Steven Boonen}, journal={Clinical Rheumatology}, year={1997}, volume={16}, pages={340-342} }