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Impact near the hip dominates fracture risk in elderly nursing home residents who fall
Authors:Wilson C. Hayes  Elizabeth R. Myers  John N. Morris  Tobin N. Gerhart  Harris S. Yett  Lewis A. Lipsitz
Affiliation:(1) Orthopaedic Biomechanics Laboratory, Charles A. Dana Research Institute, Beth Israel Hospital, 330 Brookline Avenue, 02215 Boston, Massachusetts, USA;(2) Heorew Rehabilitation Center for Aged, 1200 Center Street, 02131 Boston, Massachusetts, USA;(3) Boston Orthopaedic Group, Inc., 1269 Beacon Street, 02146 Brookline, Massachusetts, USA
Abstract:Summary Hip fractures among the elderly are a significant and rapidly growing public health problem. The prevailing view is that most hip fractures are the consequence of age-related bone loss or osteoporosis. However, because over 90% of hip fractures are the result of falls, we have undertaken a falls surveillance study to determine if factors related to the mechanics of falling are associated with increased risk of hip fracture. Case subjects with hip fracture and control subjects without hip fracture were sampled from falls recorded at the Hebrew Rehabilitation Center for Aged, a chronic care facility. Fall information was obtained by interview of the subject and witnesses if the fall was witnessed. Data were analyzed by multiple logistic regression. Increased risk of hip fracture from a fall was associated with impacting on the hip or side of the leg and potential energy associated with the fall. Quetelet, or body mass index, was inversely related to fracture risk. The adjusted odds ratio of hip fracture for a fall involving impact on the hip region was 21.7 (95% confidence interval, 8.2–58). The potential energy associated with these falls was an order of magnitude greater than the average energy required to fracture elderly, cadaveric, proximal femurs in earlier in vitro experiments. We conclude, therefore, that a fall from standing height should no longer be considered minimal trauma but rather trauma of sufficient magnitude to pose a high risk of hip fracture if impact occurs on the hip and if energy-absorbing processes are inadequate. These new findings suggest that fall mechanics play an important role in the etiology of hip fracture among the elderly.
Keywords:Hip fracture  Falls  Osteoporosis  Biomechanics
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