Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature

Abstract

Fragility fractures in the elderly is an ongoing concern for orthopaedic surgeons. A 50-year-old woman has a 40% chance of having a vertebral compression fracture in her lifetime. The incidence of vertebral fractures, reported to be more than 10 times higher than that of femoral fractures, is estimated as 1-1.5 million per year in Japan. Vertebral fractures often occur without a fall, whereas the majority of nonvertebral fractures are the consequence of falls; the site of the nonvertebral fracture appears to be dictated by the type of fall. Distal radial fractures commonly occur as a consequence of hand protection during the fall. In older patients, falling load tends to directly affect shoulder and hip joints and lead to proximal humeral and femoral fractures. The incidence of vertebral fractures is increased in women over 50 yr of age, following the same trend as osteoporosis prevalence. Conversely, the mean age for proximal femoral fractures is around 80 yr, and more than 75% of femoral fractures occur in individuals over the age of 75. The prognostic risk of aging is 11-fold greater than that of reduced bone mineral density, and age is another risk factor for femoral fractures. Prophylactic therapy for osteoporosis and femoral fractures was shown to more effective in women in their 70s than in those over the age of 80. Although several approaches, including exercise therapy, vitamin D administration, and environmental adjustment at home, have been reported to be effective in fall prevention, effective fracture prevention approaches in frail elderly individuals have not yet been well established.

Keywords: epidemiology of fracture; fall prevention; fracture prevention; proximal femoral fracture; vertebral compression fracture.

FIGURE 1

Incidence rates of three common osteoporotic fractures (proximal femur, distal radius, and proximal humerus) and others in 4139 patients who underwent surgery at Minoh City Hospital from 2002 to 2015.

FIGURE 2

(A) Fracture mechanism of hip joint, showing the force generated by the fall position. Hyperextension and valgus displacement of proximal femoral bone after trochanteric and neck fractures are explained by the load of falling position. (B) Typical radiographic images of a trochanteric femoral fracture with minimal displacement. Hyperextension and open valgus displacement are observed in the proximal femur caused by a blow to the greater trochanter during the fall. (C) Typical radiographic images of a femoral neck fracture with minimal displacement (Garden stage 1). Hyperextension and valgus compression displacement are recognized in the femoral neck, resulting from force loading during the fall. (A was redrawn with permission from Dr. Makikawa and the Japanese Society of Safety Promotion).