Wednesday, 6 April 2005

Poster Abstracts: Late-breakers

Preventing Double Hip Fractures through Extended Management of the High-Risk Population

Preliminary results emanating from the Hip Fracture Project of South Florida indicate that a significant proportion of hip fracture victims fall and break the other hip before they have fully recovered from the first fracture.

Study Purpose and rationale: The typical hip fracture victim is a "little old lady" with chronic degenerative diseases that impede and upset her mobility. Women who are at high risk for suffering a hip fracture are also at high risk for suffering a second hip fracture. They share the following characteristics: advanced old age, advanced osteoporosis, and advanced chronic conditions that have caused severe restrictions and can lead to complications during recovery. The prognosis for elderly hip fracture victims is poor, but the patient's current state of health and lack of mobility after a first hip fracture doubly compromise the prognosis of victims of second hip fractures. While researchers have determined that low bone mass contributes to skeletal fragility and is the principal cause of age-related osteoporotic fractures, bone density is not the only factor leading to hip fractures. Over 90 percent of hip fractures occur upon falling. Most elderly women experience little trauma before breaking a hip. They often say, "I just went down." All it takes is a fall from a standing position, a bed, or a chair. Women who suffer hip fractures are likely to have fallen to the side and directly impacted the hip. Women with severe osteoporosis in conjunction with a number of fall-related factors such as poor balance, slow gait, etc. are far more likely to suffer a hip fracture than women who are not fall-prone. The object behind the study is to identify, among the osteoporotic population, those who are at high risk for falls and sequential hip fractures.

Design, Population and Sample Size: I am a medical anthropologist who became interested in hip fractures as the result of the personal experience of caring for a chronically-ill mother who sustained bilateral hip fractures and died from their complications several months later. The present study was motivated by the desire to determine why the prognosis for elderly hip fracture victims is so poor. The methodological approach is anthropological: this is a qualitative study of approximately 100 hip fracture patients in South Florida and is based on direct participant-observation. Over the past four years, I have followed four groups of patients, starting with the emergency room and proceeding through acute care, rehabilitation, home care, and community-based services. By following patients through the different recuperation phases, I expect to determine not only what constitutes successful rehabilitation, in terms of length and recovery of functional abilities, but also what impact the hip fracture has on one's future prognosis. Patients and their principal caregivers are subjected to lengthy interviews and life-history profiles. During year one, patients are visited on a quarterly basis; later follow-ups include annual visits, telephone conversations, and e-mail communication. Key informants among the medical staff have also been interviewed in order to obtain a holistic vision of the recuperation process.

Major results and conclusions: Preliminary results indicate that some 3-5 percent of hip fracture victims suffer a second fracture before completing the first recovery process. Numerous articles indicate that people who have had a previous fracture are at increased risk for a second one, but the incidence of hip fracture reoccurrence is alarming. The entire concept of hip fracture management and recuperation must be urgently reevaluated in order to target the at-risk population and prevent reoccurrences with deadly consequences. A major public health intiative is necessary.

Disclosure Information:

Faculty Member's Name: Luisa Margolies, PhD
I have no relationships to disclose.

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