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Prevention of Hip Fractures

Preventing hip fractures is a major concern for the elderly because it is an extremely hard rehabilitation process to go through at that age. The most common way that elderly individuals endure hip fractures is by falling and concurrently suffering from osteoporosis.

Many studies have been conducted in order to find the best way to prevent them from happening. Two studies that were conducted in Norway showed that external hip protectors could reduce the number of hip fractures by almost 50% . Another study in Norway wanted to see the effect of hip protectors as a prevention strategy when offered as a regular part of the healthcare for residents in a nursing home. These external hip protectors were placed securely in special undergarments and were made out of stiff polypropylene on the outside and soft plastozote on the inside. The hip protectors diverted a “direct impact away from the greater trochanter during falls from standing heights . If an individual were to fall, the hip protector would transmit released energy to the tissues and muscles surrounding the femoral bone. The study showed that the use of these hip protectors had a 39% reduction rate in the incidence of hip fractures compared to those who did not wear hip protectors.

Primary Prevention

There are many other prevention strategies that do not include wearing hip protectors. Hip fracture prevention strategies can be broken up into components of primary, secondary, and tertiary prevention. Primary prevention is aimed towards populations at high risk. Prevention of bone mineral density would need to start around the time of menopause for woman due to the fluctuation of hormones even though the average age of fractures occurs in individuals aged 65 or older.

Secondary Prevention

Secondary prevention involves the screening of osteoporosis to identify those who may have a high risk.

Tertiary Prevention

Tertiary prevention involves those who have already endured an osteoporotic fracture and are susceptible in causing a new one

Drug and Non-drug Regimens

The prevention strategies can be broken into drug regimens and non-drug regimens. Hormonal replacement therapy or HRT is a prevention strategy used for women that has a fracture-reducing potential based on observational studies. Calcium and vitamin D supplementation are also used in high risk groups. The cost of this strategy is low and was found to prevent new fractures in individuals in the tertiary group. Several large studies have been performed on primary fracture prevention with calcium and vitamin D supplementation and have shown a reduction in fractures with vitamin D dosages of at least 700 IU/day . Bisphosphonates , which help to prevent the loss of bone mass, include the drugs Alendronate, Etidronate, and Residronate. They have been used in secondary and tertiary prevention. They are types of drugs that are used to treat osteoporosis and have shown to reduce hip fractures although more studies are currently being conducted. Other drug prevention therapies that are being used and studied are calcitonin, thiazide diuretics, and selective estrogen receptor modulators. Non-drug prevention strategies that are used are external hip protectors, general preventative measures, and home visits.

General Prevention

“General” preventative measures include gait training, use of canes or other equipment to help with balance and gait, and the removal of hazardous material in homes such as loose flooring or improvement of the lightning in the home for the reduction of falls. A home visit by trained therapists or nurses specifically trained in this field is a preventative measure that is very costly.

This illustration, drawn by myself, gives a demonstration of the placement of the hip protectors. The red outline represents the special undergarment that is worn to keep the protector in place and the grey outline depicts the hip protectors that are placed inside the underwear.