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Arm
Fractures indicate greater risk of Hip
Fractures in Elderly Patients
Newswise — Elderly women with upper arm
fractures are five times more likely than
the general population to experience a
broken hip in the 12 months following the
arm fracture, according to a study published
in the March 2009 issue of The
Journal of Bone and Joint Surgery (JBJS).
Understanding that risk can be a key to
preventing those fractures, the study notes.
“There have been studies in the past showing
a relationship between upper arm fractures
and
hip fractures, but we wanted to
determine when that risk is greatest, “ says
Jeremiah Clinton, MD, an orthopaedic surgeon
and associate professor of orthopaedics at
the University of Washington in Seattle.
“By recognizing when that period of
increased risk occurs, physicians have a
window of opportunity to take steps that may
possibly prevent a subsequent fracture.”
“The older population is at a greater risk
for
fall-related fractures, due to
the fact that their bones are generally more
brittle than the younger population,” Dr.
Clinton adds.
“These types of low-energy fractures are
referred to in the literature as ‘fragility
fractures.’”
Elderly patients may fall due to a number of
reasons, including:
• effects of medications
• neurological disorders
• loss of an ability to maintain balance
• decreased reaction time
Because there can be a number of underlying
factors, Dr. Clinton says a
multi-disciplinary approach is needed to
effectively assess the patient’s future
risk.
“One of the first steps a patient should
take following a fall is to talk with their
orthopaedist and other physicians to
determine the cause,” he notes.
“Once the cause is more clearly understood,
the proper steps can be taken to decrease a
patient’s risk of having another fall and
potentially future fractures.”
Morbidity statistics for hip fracture
patients are high. Dr. Clinton notes past
studies that indicate 25 percent of patients
who experience hip fractures have a survival
rate of less than one year, while another 25
percent will lose some level of their
independence and potentially need to move to
an assisted living facility.
As the world’s population ages, the
potential social and economic costs are
huge, he says.
Although this study examined fractures in an
elderly female population, Dr. Clinton notes
that longer life spans in the United States
and elsewhere make male patients vulnerable,
as well.
“When we look at the numbers, we can see
that there is a huge increase in the
population that maybe at risk for these
types of fragility fractures, and if we look
only at the costs associated with treating
hip fractures, we are talking about hundreds
of millions, or probably billions, of
dollars in health care costs,” Dr. Clinton
adds.
“Much of those costs theoretically could be
decreased if we knew when and how to
intervene.”
Although the exact relationship between arm
and hip fractures is not entirely
understood, Dr. Clinton says “there is
evidence to support that both fractures stem
from similar reactions to a fall.
"When
patients’ age their reflexes slow down and
they may not have the time or ability to
correctly position themselves as they fall,
he noted.
“Rather than trying to catch themselves as a
younger patient would do” notes Dr. Clinton,
“studies show that elderly people have a
tendency to simply tuck and roll, which
causes greater force on the shoulder and
hip.”
Dr. Clinton recommends the following steps
for patients experiencing a fall:
• talk to an internist to help determine any
potential underlying medical cause of the
fall
• consider the use of bone-strengthening
drugs, called “biphosphenates”
• talk to an occupational therapist about
modifying the living area and using
assistive devices to prevent falls
“The use of biphosphenates may be good,
preventative advice for elderly patients at
risk for fractures, whether or not the
patient has had a fracture,” added Dr.
Clinton.
“What I tell my patients is that we have
ample evidence now to support the use of
biphosphenates to reduce the risk of
fragility fractures, and especially reduce
the risk of hip fractures, even within the
first year of starting the medication,”
noted Dr. Clinton.
“In my opinion, this is good advice for
anyone facing the possibility of a fragility
fracture, not just those who have already
experienced a fracture
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