Hip fractures in the elderly without osteoporosis

Abstract

In clinical practice, hip fracture is a very common reason for hospital admission in the elderly. Most subjects over the age of 65 years, experience an injury at the hip mostly after a fall. Many elderly persons suffer from osteoporosis, which is characterised by loss of bone mass and deterioration of bone microarchitecture thus increasing the susceptibility to fracture. Osteoporosis is defined by WHO as a Bone Mineral Density (BMD) of 2.5 standard deviations (SD) below that of a young adult as assessed by dual energy x-ray absorptiometry (DXA). It has been shown that some patients with a hip fracture have either normal or "osteopenic" hips as defined by DXA (-2.5 <T-score<1). Other diseases that usually affect the elderly population may constitute independent risk factors for falls and fractures, such as diabetes mellitus, neurologic conditions, sarcopenia, use of medication. The clinician's role apart from treating osteoporosis is also to address secondary causes related to increase risk of fracture including falls in order to decrease the incidence of hip fractures. This article addresses some common pathological conditions that have been shown to predispose for hip fractures individuals regardless of their DXA BMD status.

Association of early vertebroplasty with risk of hip replacement

“…Although osteoporosis is prevalent in subjects with vertebral fracture and hip fracture, sarcopenia is another key point. People with sarcopenia have a 3-fold increased risk for a fall [ 22 ] and patients with TLCF also often develop sarcopenia, which is a condition characterized by loss of skeletal muscle mass and strength, along with physical dysfunction and a risk of death. Takahashi, K., et al reported that patients with TLCF have significantly decreased muscle mass, and the prevalence of sarcopenia in these patients is 22.7% to 43.7%, which is higher than the prevalence of other orthopedic disorders.…”

Human umbilical cord mesenchymal stromal cells promotes the proliferation and osteogenic differentiation of autologous bone marrow stem cells by secreting exosomes

“…Decreased bone density is a recognized risk factor for hip fractures. Within 50–80 years of age, the risk of hip fractures increase by 4 times due to the decreased bone density [ 2 ]. Senior hip fracture victims, who have comorbidities in the circulatory, respiratory, digestive, neurological, and urinary systems after staying in bed, will soon develop lung and urinary system infections, deep vein thrombosis in the lower extremities, bedsores, cardiovascular and cerebrovascular accidents, and multiple systemic organ failure.…”