Current Osteoporosis Reports

, Volume 1, Issue 2, pp 78–85

Hip fracture: Risk factors and outcomes

  • Lois E. Wehren
  • Jay Magaziner


Hip fracture is an important public health and personal burden, and this burden is anticipated to increase over the next several decades. Although white women experience the greatest lifetime risk of hip fracture, risk extends to men and to nonwhite populations. Bone strength, risk of falling, and individual clinical characteristics combine to affect the risk of hip fracture. Nearly $9 billion were expended in 1995 in the United States for the management of hip fractures. Hip fracture has important sequelae, including loss of bone and muscle mass. Mortality is significantly increased after hip fracture, and functional recovery is limited to less than 50% of those who fracture. About 25% of patients reside in long-term care facilities for a year or more after fracture, and the impact of hip fracture on health-related quality of life is considerable and long lasting.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    American Academy of Orthopaedic Surgeons: Position Statement: Hip Fracture in Seniors: a Call for Health System Reform. Illinois: AAOS; 1999.Google Scholar
  2. 2.
    Melton LJI: Epidemiology of osteoporosis: predicting who is at risk. Ann NY Acad Sci 1990, 592:295–306.PubMedCrossRefGoogle Scholar
  3. 3.
    National Osteoporosis Foundation. Osteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-effectiveness analysis. Osteoporos Int 1998, 8(Suppl 4):S1-S88. This document is the source of the most generally accepted guidelines in the United States for the management of osteoporosis, and summarizes evidence published to that date. Cost-effectiveness analyses largely depend on hip fracture impact.Google Scholar
  4. 4.
    Gullberg B, Johnell O, Kanis JA: World-wide projections for hip fracture. Osteoporos Int 1997, 7:407–413.PubMedCrossRefGoogle Scholar
  5. 5.
    Eastell R, Boyle IT, Compston J, et al.: Management of male osteoporosis: report of the UK Consensus Group. Q J Med 1998, 91:71–92. Men get osteoporosis and are at risk for hip fracture. This paper summarizes much of what is known for men, who are a greatly understudied group at risk.Google Scholar
  6. 6.
    Cummings SR, Nevitt MC, Browner WS, et al.: Risk factors for hip fracture in white women. N Engl J Med 1995, 332:767–773.PubMedCrossRefGoogle Scholar
  7. 7.
    Johnell O, Gullberg B, Kanis JA, et al.: Risk factors for hip fracture in European women: the MEDOS study. J Bone Miner Res 1995, 10:1802–1815.PubMedCrossRefGoogle Scholar
  8. 8.
    Miller PD, Siris ES, Barrett-Connor E, et al.: Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 2002, 17:2222–2230. This paper describes results of a very large multiethnic study of osteoporosis and fracture in postmenopausal women, and shows that peripheral BMD measurements predict hip fracture (and other fractures) very well. The short follow-up period minimizes change in covariates, so the association between BMD and fracture risk is clear.PubMedCrossRefGoogle Scholar
  9. 9.
    Albrand G, Munoz F, Sornay-Rendu E, et al.: Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone 2003, 32:78–85.PubMedCrossRefGoogle Scholar
  10. 10.
    NIH Consensus Development Panel: Osteoporosis prevention, diagnosis, and therapy. JAMA 2001, 285:785–795.CrossRefGoogle Scholar
  11. 11.
    National Osteoporosis Foundation: America’s Bone Health: The State of Osteoporosis and Low Bone Mass in Our Nation. Washington, DC: National Osteoporosis Foundation; 2002.Google Scholar
  12. 12.
    Marshall D, Johnell O, Wedel H: Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Br Med J 1996, 312:1254–1259.Google Scholar
  13. 13.
    Faulkner KG, Cummings SR, Black D, et al.: Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. J Bone Miner Res 1993, 8:1211–1217.PubMedGoogle Scholar
  14. 14.
    Crabtree NJ, Kroger H, Martin A, et al.: Improving risk assessment: hip geometry, bone mineral distribution and bone strength in hip fracture cases and controls. The EPOS study. Osteoporos Int 2002, 13:48–1354.PubMedCrossRefGoogle Scholar
  15. 15.
    Michelotti J, Clark J: Femoral neck length and hip fracture risk. J Bone Miner Res 1999, 14:1714–1720.PubMedCrossRefGoogle Scholar
  16. 16.
    Wehren LE, Beck TJ, Oreskovic TL, Magaziner J: Hip structural analysis in women with cervical and intertrochanteric fractures [abstract]. Osteoporos Int 2002, 13(Suppl 1):S67.Google Scholar
  17. 17.
    Ciarelli TE, Fyhrie DP, Schaffler MB, Goldstein SA: Variations in three-dimensional cancellous bone architecture of the proximal femur in female hip fractures and in controls. J Bone Miner Res 2000, 15:32–40.PubMedCrossRefGoogle Scholar
  18. 18.
    Jordan GR, Loveridge N, Bell KL, et al.: Spatial clustering of remodeling osteons in the femoral neck cortex: a cause of weakness in hip fracture? Bone 2000, 26:305–313.PubMedCrossRefGoogle Scholar
  19. 19.
    Looker AC, Bauer DC, Chesnut CHI, et al.: Clinical use of biochemical markers of bone remodeling: current status and future directions. Osteoporos Int 2000, 11:467–480.PubMedCrossRefGoogle Scholar
  20. 20.
    Burr DB, Forwood MR, Fyhrie DP, et al.: Bone microdamage and skeletal fragility in osteoporotic and stress fractures. J Bone Miner Res 1997, 12:6–15.PubMedCrossRefGoogle Scholar
  21. 21.
    Mori S, Harruff R, Ambrosius W, Burr DB: Trabecular bone volume and microdamage accumulation in the femoral heads of women with and without femoral neck fractures. Bone 1997, 21:521–526.PubMedCrossRefGoogle Scholar
  22. 22.
    Turner CH: Biomechanics of bone: determinants of skeletal fragility and bone quality. Osteoporos Int 2002, 13:97–104.PubMedCrossRefGoogle Scholar
  23. 23.
    Peacock M, Turner CH, Econs MJ, Foroud T: Genetics of osteoporosis. Endocr Rev 2002, 23:303–326.PubMedCrossRefGoogle Scholar
  24. 24.
    Boyden LM, Mao J, Belsky J, et al.: High bone density due to a mutation in LDL-receptor-related protein 5. N Engl J Med 2002, 346:1513–1521.PubMedCrossRefGoogle Scholar
  25. 25.
    Efstathiadou Z, Tsatsoulis A, Ioannidis JPA: Association of collagen I-alpha-1 Sp1 polymorphism with the risk of prevalent fractures: a meta-analysis. J Bone Miner Res 2001, 16:1586–1592.PubMedCrossRefGoogle Scholar
  26. 26.
    Parkkari J, Kannus P, Palvanen M, et al.: Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 1999, 65:183–187.PubMedCrossRefGoogle Scholar
  27. 27.
    Davies JC, Manning DP, Kemp GJ, Frostick SP: The rising number of underfoot accidents after the menopause causes both fractures and non-fracture injuries. Q J Med 2001, 94:699–707.Google Scholar
  28. 28.
    Dargent-Molina P, Favier F, Grandjean H, et al.: Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 1996, 348:145–149.PubMedCrossRefGoogle Scholar
  29. 29.
    van Schoor NM, Deville WL, Bouter LM, Lips P: Acceptance and compliance with external hip protectors: a systematic review of the literature. Osteoporos Int 2002, 13:917–924.PubMedCrossRefGoogle Scholar
  30. 30.
    Writing Group for the Women’s Health Initiative Investigators: Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002, 288:321–333. This clinical trial, which showed net harm associated with the use of estrogen/progestin, has led to widespread changes in our approach to the management of the postmenopausal woman.CrossRefGoogle Scholar
  31. 31.
    Wells G, Tugwell P, Shea B, et al.: Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. Endocr Rev 2002, 23:529–539.PubMedCrossRefGoogle Scholar
  32. 32.
    Michaelsson K, Baron JA, Farahmand BY, Ljunghall S: Use of low potency estrogens does not reduce the risk of hip fracture. Bone 2002, 30:613–618.PubMedCrossRefGoogle Scholar
  33. 33.
    Ascott-Evans BH, Guanabens N, Kivinen S, et al.: Alendronate prevents loss of bone density associated with discontinuation of hormone replacement therapy. Arch Intern Med 2003, 163:789–794.PubMedCrossRefGoogle Scholar
  34. 34.
    Beck TJ, Stone KL, Oreskovic TL, et al.: Effects of current and discontinued estrogen replacement therapy on hip structural geometry: the study of osteoporotic fractures. J Bone Miner Res 2001, 16:2103–2110.PubMedCrossRefGoogle Scholar
  35. 35.
    Barrett-Connor E, Wehren L, Yates AJ, et al.: Rapid loss of hip anti-fracture efficacy following estrogen cessation: evidence from NORA [abstract]. Obstet Gynecol 2003, 101(Suppl 4):5S.CrossRefGoogle Scholar
  36. 36.
    Klotzbuecher C, Ross P, Landsman P, et al.: Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 2000, 15:721–739.PubMedCrossRefGoogle Scholar
  37. 37.
    Kamel HK, Hussain MS, Tariq S, et al.: Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med 2000, 109:326–328.PubMedCrossRefGoogle Scholar
  38. 38.
    Kanis JA: The use of calcium in the management of osteoporosis. Bone 1999, 24:279–90.PubMedCrossRefGoogle Scholar
  39. 39.
    Chapuy MC, Pamphile R, Paris E, et al.: Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int 2002, 13:257–264.PubMedCrossRefGoogle Scholar
  40. 40.
    Dawson-Hughes B, Harris SS, Krall EA, Dallal GE: Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997, 337:670–676.PubMedCrossRefGoogle Scholar
  41. 41.
    Ooms ME, Roos JC, Bezemer PD, et al.: Prevention of bone loss by vitamin D supplementation in elderly women: a randomized double-blind trial. J Clin Endocrinol Metab 1995, 80:1052–1058.PubMedCrossRefGoogle Scholar
  42. 42.
    Meyer HE, Smedshaug GB, Kvaavik E, et al.: Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial. J Bone Miner Res 2002, 17:709–715.PubMedCrossRefGoogle Scholar
  43. 43.
    Law MR, Hackshaw AK: A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. Br Med J 1997, 315:841–846.Google Scholar
  44. 44.
    Cornuz J, Feskanich D, Willett WC, Colditz GA: Smoking, smoking cessation, and risk of hip fracture in women. Am J Med 1999, 106:311–314.PubMedCrossRefGoogle Scholar
  45. 45.
    Feskanich D, Korrick SA, Greenspan SL, et al.: Moderate alcohol consumption and bone density among postmenopausal women. J Women’s Health 1999, 8:65–73.Google Scholar
  46. 46.
    Hoidrup S, Gronbaek M, Gottschau A, et al.: Alcohol intake, beverage preference, and risk of hip fracture in men and women. Am J Epidemiol 1999, 149:993–1001.PubMedGoogle Scholar
  47. 47.
    Wang PS, Solomon DH, Mogun H, Avorn J: HMG-CoA reductase inhibitors and the risk of hip fractures in elderly patients. JAMA 2000, 283:3211–3216.PubMedCrossRefGoogle Scholar
  48. 48.
    van Staa T-P, Wegman S, de Vries F, et al.: Use of statins and risk of fractures. JAMA 2001, 285:1850–1855.PubMedCrossRefGoogle Scholar
  49. 49.
    Lau EMC, Suriwongpaisal P, Lee JK, et al.: Risk factors for hip fracture in Asian men and women: the Asian Osteoporosis Study. J Bone Miner Res 2001, 16:572–580.PubMedCrossRefGoogle Scholar
  50. 50.
    Clark P, de la Pena F, Garcia FG, et al.: Risk factors for osteoporotic hip fractures in Mexicans. Arch Med Res 1998, 29:253–257.PubMedGoogle Scholar
  51. 51.
    Meyer HE, Tverdal A, Falch JA: Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol 1993, 137:1203–1211.PubMedGoogle Scholar
  52. 52.
    Mussolino ME, Looker AC, Madans JH, et al.: Risk factors for hip fracture in white men: the NHANES I Epidemiologic Follow-up study. J Bone Miner Res 1998, 13:918–924.PubMedCrossRefGoogle Scholar
  53. 53.
    Yu-Yahiro JA, Michael RH, Dubin NH, et al.: Serum and urine markers of bone metabolism during the year after hip fracture. J Am Geriatr Soc 2001, 49:877–883.PubMedCrossRefGoogle Scholar
  54. 54.
    Fox KM, Magaziner J, Hawkes WG, et al.: Loss of bone density and lean body mass after hip fracture. Osteoporos Int 2000, 11:31–35.PubMedCrossRefGoogle Scholar
  55. 55.
    Karlsson M, Nilsson JA, Sernbo I, et al.: Changes of bone mineral mass and soft tissue composition after hip fracture. Bone 1996, 18:19–22.PubMedCrossRefGoogle Scholar
  56. 56.
    Dirschl DR, Henderson RC, Oakley WC: Accelerated bone mineral loss following a hip fracture: a prospective longitudinal study. Bone 1997, 20:79–82.CrossRefGoogle Scholar
  57. 57.
    Bischoff HA, Solomon DH, Dawson-Hughes B, et al.: Repeat hip fractures in a population-based sample of Medicare recipients in the US: timing and gender differences [abstract]. J Bone Miner Res 2001, 16(Suppl 1):S213.Google Scholar
  58. 58.
    Poor G, Atkinson EJ, O’Fallon WM, Melton LJI: Determinants of reduced survival following hip fractures in men. Clin Orthop 1995, 319:260–265.PubMedGoogle Scholar
  59. 59.
    Browner WS, Pressman AR, Nevitt MC, Cummings SR: Mortality following fractures in older women: the Study of Osteoporotic Fractures. Arch Intern Med 1996, 156:1521–1525.PubMedCrossRefGoogle Scholar
  60. 60.
    Wehren LE, Hawkes W, Hebel JR, et al.: Gender difference in mortality after hip fracture [abstract]. Osteoporos Int 2000, 11(Suppl 2):S151-S52.Google Scholar
  61. 61.
    Magaziner J, Lydick E, Hawkes W, et al.: Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health 1997, 87:1630–1636.PubMedCrossRefGoogle Scholar
  62. 62.
    Lawrence VA, Hilsenbeck SG, Noveck H, et al.: Medical complications and outcomes after hip fracture repair. Arch Intern Med 2002, 162:2053–2057.PubMedCrossRefGoogle Scholar
  63. 63.
    Wehren LE, Hawkes W, Orwig DL, et al.: The role of infection in gender differences in mortality after hip fracture [oral presentation]. J Bone Miner Res 2001, 16(Suppl 1):S162.Google Scholar
  64. 64.
    Halm EA, Magaziner J, Hannan EL, et al.: Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture. Arch Intern Med 2003, 163:107–112.CrossRefGoogle Scholar
  65. 65.
    Boockvar KS, Halm EA, Litke A, et al.: Hospital readmissions after hospital discharge for hip fracture: surgical and nonsurgical causes and effect on outcomes. J Am Geriatr Soc 2003, 51:399–403.PubMedCrossRefGoogle Scholar
  66. 66.
    Magaziner J, Simonsick EM, Kashner TM, et al.: Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 1990, 45:M101-M07.PubMedGoogle Scholar
  67. 67.
    Cree M, Soskolne CL, Belseck E, et al.: Mortality and institutionalization following hip fracture. J Am Geriatr Soc 2000, 48:283–288.PubMedGoogle Scholar
  68. 68.
    Jette AM, Harris BA, Cleary PD, Campion EW: Functional recovery after hip fracture. Arch Phys Med Rehabil 1987, 68:735–740.PubMedGoogle Scholar
  69. 69.
    Magaziner J, Hawkes W, Hebel JR, et al.: Recovery from hip fracture in eight areas of function. J Gerontol 2000, 55A:M498-M507. Evidence reported here suggests that recovery following hip fracture follows a necessary sequence, and that improvement in certain areas is a necessary prerequisite to improvement in others. Recognition of this may help investigators design interventions to optimize hip fracture recovery.Google Scholar
  70. 70.
    Dolan MM, Hawkes WG, Zimmerman SI, et al.: Delirium on hospital admission in aged hip fracture patients: prediction of mortality and 2-year functional outcomes. J Gerontol 2000, 55A:M527-M534.Google Scholar
  71. 71.
    Eastwood EA, Magaziner J, Wang J, et al.: Patients with hip fracture: subgroups and their outcomes. J Am Geriatr Soc 2002, 50:1240–1249.PubMedCrossRefGoogle Scholar
  72. 72.
    Brazier JE, Green C, Kanis JA: A systematic review of health state utility values for osteoporosis-related conditions. Osteoporos Int 2002, 13:768–776.PubMedCrossRefGoogle Scholar
  73. 73.
    Randell AG, Nguyen TV, Bhalerao N, et al.: Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int 2000, 11:460–466.PubMedCrossRefGoogle Scholar
  74. 74.
    Johnell O, Kanis JA, deLaet C, et al.: Sequential changes in quality of life after osteoporotic fractures [abstract]. Osteoporos Int 2002, 13(Suppl 1):S70.Google Scholar
  75. 75.
    Adachi JD, Ioannidis G, Berger C, et al.: The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada. Osteoporos Int 2001, 12:903–908.PubMedCrossRefGoogle Scholar
  76. 76.
    Wehren LE, Barrett-Connor E: Quality of life in postmenopausal women with a history of fracture of the rib, spine, wrist, or hip: evidence from NORA. J Bone Miner Res 2002, 17(Suppl 1):S359.Google Scholar
  77. 77.
    PraemerA, Furner S, Rice DP: Musculoskeletal Conditions in the United States. Chicago: American Academy of Orthopedic Surgeons; 1992.Google Scholar
  78. 78.
    Chrischilles E, Shireman T, Wallace R: Costs and health effects of osteoporotic fractures. Bone 1994, 15:377–386.PubMedCrossRefGoogle Scholar
  79. 79.
    Brainsky A, Glick H, Lydick E, et al.: The economic cost of hip fractures in community-dwelling older adults: a prospective study. J Am Geriatr Soc 1997, 45:281–287.PubMedGoogle Scholar
  80. 80.
    Khasraghi FA, Lee EJ, Christmas C, Wenz JF: The economic impact of medical complications in geriatric patients with hip fracture. Orthopedics 2003, 26:49–53.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Lois E. Wehren
  • Jay Magaziner
    • 1
  1. 1.Division of Gerontology, Department of Epidemiology and Preventive MedicineSchool of Medicine University of MarylandBaltimoreUSA

Personalised recommendations