The Fracture Liaison Service has successfully identified and evaluated most patients with fractures. Only those patients who declined were not evaluated. The ultimate success of the program will be measured by the subsequent fracture experience of these patients, but clear improvements in diagnosing and treating low bone mineral density in patients with fracture have already been demonstrated.

Despite the increase in numbers of the extreme elderly, little data is available regarding their outcome after surgery for fracture of the hip. We performed a prospective study of 50 patients aged 95 years and over who underwent this procedure. Outcome measures included morbidity, mortality, hospital stay, residential and walking status. Comparison was made with a control group of 200 consecutive patients aged less than 95 years who had a similar operation. The mortality at 28 and 120 days was higher (p = 0.005, p = 0.001) in the patients over 95 years. However, the one-year cumulative post-operative mortality was neither significantly different between the two groups (p = 0.229) nor from the standardised mortality rate for the age-matched population (p = 0.445). Predictors of mortality included the ASA grade, the number of comorbid medical conditions and active medical problems on admission. Patients over 95 were unlikely to recover their independence and at a mean follow-up of 29.3 months (12.1 to 48) 96% required permanent institutional care.More than 60% of patients with a fracture of the hip have significant coexisting medical problems at the time of presentation, 1 and a one-year mortality rate of between 14% and 47% has been reported. [2][3][4][5][6][7][8][9][10][11][12] The lifetime incidence of hip fracture in the United Kingdom is approximately 18% in women and 6% in men. 13 The annual incidence increases with age, rising from three per 100 women aged between 65 and 74 to 12.6 per 100 aged 85 or older. 14,15 At present there are some 250 000 people over the age of 95 residing in the United Kingdom and it is predicted that this number will increase dramatically over the next decade. 16Previous studies have associated advanced age with increased mortality after hip fracture, [17][18][19][20][21][22] and increasing age has been linked with poorer functional recovery, diminished walking ability and increased post-operative complications. 6,8,17,18,21,22 Extremely old patients represent a small but challenging subpopulation of those with fractures of the hip, but there is little published in the way of specific outcome. Patients and MethodsPatients aged 95 years and older presenting with a fracture of the hip were identified prospectively on presentation from the start of 2000 and were followed up until September 2004 either until their death or to the conclusion of the study. Follow-up information was collected from medical, general practitioner (GP) and physiotherapy/occupational therapy records and, where possible, the patients were also contacted. If a patient was unable to give the appropriate information, a family member, carer or GP was then interviewed. The data were compared that from a control cohort consisting of 200 consecutive individuals under the age of 95 who underwent similar surgery during the period of study. The control group was followed up for a period of 12 months.All fracture types were included. In the control group four patients (2%) sustained fractures which were subsequently h...

Osteoporosis and fragility fractures in men constitute a considerable burden in healthcare. We have reviewed 2035 men aged over 50 years with 2142 fractures to clarify the epidemiology of these injuries and their underlying risk factors. The prevalence of osteoporosis ranged between 17.5% in fractures of the ankle and 57.8% in those of the hip. The main risk factors associated with osteoporosis were smoking (47.4%), alcohol excess (36.2%), body mass index < 21 (12.8%) and a family history of osteoporosis (8.4%). Immobility, smoking, self-reported alcohol excess, a low body mass index, age >/=72 and loss in height were significantly more common among men with fractures of the hip than in those with fractures elsewhere.

In patients with nonvertebral fractures, VFA identifies a substantial burden of prevalent vertebral fractures that have not hitherto been recognized. Nevertheless, VFA seldom influences the need for treatment for fracture secondary prevention after a nonvertebral fracture.