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Fragilité, ostéoporose et fracture du col du fémur: causes, conséquences et perspectives thérapeutiques

Frailty, osteoporosis and hip fracture: causes, consequences and therapeutic perspectives

  • Article de Synthèse / Review Article
  • Published:
Les cahiers de l'année gérontologique

Résumé

Le patient âgé fragile est un sujet à haut risque de fracture de hanche. Toutefois, il accède peu à l’organisation aux mesures prévenant la chute et rarement à l’approche diagnostique et thérapeutique de l’ostéoporose. Cette revue de la littérature porte sur les liens entre le syndrome de fragilité et le risque de fracture de hanche. Elle fut discutée lors d’une réunion d’un groupe de gériatres, d’endocronologues, de rhumatologues et de gynécologistes. Le concept de fragilité permet d’envisager une approche différente du risque de fracture de hanche des sujets âgés. Des perspectives de prévention, d’organisation des soins spécifiques semblent pertinentes au sein de cette population. Le modèle classique, voulant que l’on traite individuellement chaque pathologie, se prête mal à la prise en charge du sujet fragile. L’approche diagnostique de l’ostéoporose axée sur la majoration de la densité minérale osseuse (DMO) est nécessaire mais probablement insuffisante dans cette population. L’objectif thérapeutique ne peut pas se limiter à l’augmentation de la DMO. La prévention de la chute en améliorant les facteurs déterminant du syndrome de fragilité (force, statut nutritionnel, activité physique, cognition) sont des approches thérapeutiques qui devraient limiter l’incidence des fractures. Des études supplémentaires, orientées vers le sujet fragile, permettraient de mieux comprendre les effets de la prise en charge de la fragilité sur la fracture. En parallèle, la prise en charge plus systématique de l’ostéoporose devrait limiter le risque d’une personne âgée robuste de devenir fragile et d’une personne fragile de devenir dépendante.

Abstract

Elderly, frail patients are at considerable risk of hip fracture. Yet, they receive little advice about measures that can be taken in order to avoid falling, and little screening or treatment for osteoporosis. This review of the literature focuses on the links between the frailty syndrome and the risk of hip fracture. It has been discussed at a meeting involving geriatricians, endocrinologists, rhumatologists and gynaecologists. The concept of frailty enables us to consider a different approach to the elderly person’s risk of hip fracture. It would seem advisable to consider preventive measures and specific treatment for the elderly, frail population. The usual approach, involving the treatment of each pathology as an individual case, does not seem appropriate for managing the frail individual. The approach that bases osteoporosis treatment on increasing bone mineral density is not only necessary but also probably inadequate here — the treatment objective must not only be to increase bone mineral density. Preventing falls by improving the determining factors of frailty (strength, nutritional status, physical activity and cognition) should result in fewer fractures. Supplementary studies of frail subjects would improve our understanding of how managing frailty might impact on fracrture rates. At the same time, proper management of osteoporosis should reduce the risk of strong, elderly patients becoming frail and frail subjects becoming dependent.

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Authors and Affiliations

  1. Service de médecine interne et de gérontologie clinique, pavillon Junot, 170, avenue de Casselardit, hôpital La Grave-Casselardit, F-31300, Toulouse, France

    Y. Rolland

  2. Inserm U558, Université de Toulouse III, F-31073, Toulouse, France

    Y. Rolland, G. Abellan van Kan, F. Nourhashémi & B. Vellas

  3. Centre de Gériatrie, CHU de Nancy, INSERM Unité U684, F-54 500, Vandœuvre-lès-Nancy, France

    A. Bénétos

  4. Pôle de Gérontologie, Centre de Prévention et de Traitement des Maladies du Vieillissement, CHU Montpellier, 39, avenue Charles Flahault, F-34295, Montpellier Cedex 5, France

    H. Blain & C. Jeandel

  5. Service de Médecine Gériatrique, CHU Lyon-Sud, F-69495, Pierre-Bénite Cedex, France

    M. Bonnefoy

  6. Service Médecine Interne Gériatrique, CHU Hôpital de Bois-Guillaume, F-76031, Rouen Cedex, France

    P. Chassagne

  7. Service de Rhumatologie, CHU Rangueil, 1, avenue J. Poulhès, F-31043, Toulouse Cedex, France

    M. Laroche

  8. Service de Rhumatologie, CHU Lariboisière, 2, rue Ambroise Paré, F-75475, Paris, France

    P. Orcel

  9. Hôpital Charles Foix, APHP, Université PM Curie, F-94200, Ivry-sur-Seine, France

    F. Piette

  10. Centre de Ménopause, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande-Bretagne, TSA 70034, F-31059, Toulouse cedex 9, France

    C. Ribot

  11. Service de Médecine, CHU d’Angers, F-49033, Angers Cedex 1, France

    P. Ritz

  12. Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, F-75014, Paris, France

    C. Roux

  13. Pôle Vieillissement, Réadaptation et Accompagnement, Hôpital Universitaire Paul Brousse, 14, Avenue Paul Vaillant Couturier, F-94800, Villejuif, France

    J. Taillandier

  14. CHU Brabois Avenue de Bourgogne, F-54500, Vandœuvre-lès-Nancy, France

    G. Weryha

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  1. Y. Rolland
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  2. G. Abellan van Kan
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  15. J. Taillandier
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  16. F. Trémollières
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  17. G. Weryha
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  18. B. Vellas
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Correspondence to Y. Rolland.

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Rolland, Y., Abellan van Kan, G., Bénétos, A. et al. Fragilité, ostéoporose et fracture du col du fémur: causes, conséquences et perspectives thérapeutiques. cah. année gerontol. 1, 172–187 (2009). https://doi.org/10.1007/s12612-009-0029-5

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  • DOI: https://doi.org/10.1007/s12612-009-0029-5

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