Hip fracture

Oral calcium has long been used for the treatment of osteoporosis, both in the form of dietary and pharmacological supplements. In patients with calcium deficiency, oral calcium at doses of 1000-1500 mg/day corrects a negative calcium balance and suppresses PTH secretion. Sufficient calcium intake is most important for the acciual of peak bone mass in the young, but is also considered the basis of most anti-osteoporotic regimens. In the elderly, supplementation with oral calcium and vitamin D reduces the risk of hip fracture by about 30 4-0%. 

Summary term for a number of steroid hormones and their precursors with differentiation-inducing activity in many tissues. As regards bone, three components are relevant cholecalciferol ( vitamin D ) 25-hydroxyvi-taminD3 (calcidiol) and 1,25-dihydroxy vitamin D3 (calcitriol). The latter is the biologically active form and increases both intestinal calcium absoiption and bone resorption. Vitamin D preparations are widely used for the treatment of osteoporosis. Daily supplementation with vitamin D reduces bone loss in postmenopausal women and hip fractures in elderly subjects. 

This illness is mainly characterized by an age-related bone loss. The detection of osteocalcin in bone was the starting point for a series of studies on the role of vitamin K-dependent proteins in bone development and maintenance and on possible supplemantation therapies. Epidemiologic studies found differences in the risk of hip fractures depending on the dietary vitamin K... 

Most hip fractures occur in postmenopausal Caucasian women they also have the highest incidence of fracture when adjusted for age.4 The incidence of osteoporosis and low bone... 

Efforts to decrease the risk of falling include balance training, muscle strengthening, removal of hazards in the home, installation of fall-reduction measures such as handrails in the home, and discontinuation of predisposing medications.1,2,10 Additionally, the use of hip protectors is an effective way to prevent hip fractures, although adherence to this measure is poor, and some patients may not be amenable to wearing them at all.10... 

Without Vascular Insufficiency Adult (greater 50 years) Postoperative (e.g., hip fractures), soft-tissue infections 5. aureus Nafci 11 i n or cefazolin... 

Postmenopausal women (mean 75 y) N=513 Observational Risk of hip fracture 24-hour diet recall No association between risk of hip fracture and caffeine intake. 

Peri- and postmenopausal women (50-84 y) N=1817 Observational Hip fracture Self report of coffee and tea intake... 

Caffeine intake equivalent to 2 or more cups/day (estimated from self-report and imputed caffeine values) was associated with a significantly increased hip fracture risk in women less than 65 years old. 

Reported that only coffee among caffeine sources was the significant predictor of hip fracture, although no association between caffeine intake and forearm fracture found. No association between bone density and caffeine intake, although caffeine was found to have significant negative effect on calcium metabolism. 

Holbrook, T. L., Barrett-Connor, E., Wingard, D. L., Dietary calcium and risk of hip fracture 14 year prospective population study, Lancet, 2, 1046, 1988. 

Only vertebral fractures have been documented to decrease with intranasal calcitonin therapy. Calcitonin does not consistently affect hip BMD and does not decrease hip fracture risk. 

Major lower extremity orthopedic surgery Hip fracture Multiple trauma... 

Prophylaxis should be continued throughout the period of risk. For general surgical procedures and medical conditions, prophylaxis can be discontinued once the patient is able to ambulate regularly and other risk factors are no longer present. Most clinical trials support the use of antithrombotic therapy for 21 to 35 days after total hip replacement and hip fracture repair surgeries. 

The continuous combined oral estrogen-progestogen arm of the Women s Health Initiative (WHI) study was terminated prematurely after a mean of 5.2-year follow-up because of the occurrence of a prespecified level of invasive breast cancer. The study also found increased coronary disease events, stroke, and pulmonary embolism. Beneficial effects included decreases in hip fracture and colorectal cancer. 

Hip fracture repair 5. aureus, S. epidermidis Cefazolin 1 gx 1 preoperatively, then every 8 hours for 48 hours Compound fractures are treated as if infection is presumed IA... 

Cefazolin is the best-studied antibiotic and is thus the drug of choice. For hip fracture repairs and joint replacements, it should be administered for 24 hours. Vancomycin is not recommended unless a patient has a history of /3-lactam hypersensitivity or the propensity for MRSA infection at the institution necessitates its use. 

There is an association between falls and hip fractures and the use of long-elimination half-life benzodiazepines thus, flurazepam and quazepam should be avoided in the elderly. 

Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK (1993) Bone density at various sites for prediction of hip fractures. The study of osteoporotic fractures research group. Lancet 341 72-75... 

Femoral neck bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Osteoporos Int 11 714-720... 

Rejnmark L, Olsen ML, Johnsen SP et al. (2004) Hip fracture risk in statin users. A population based Danish case control study. Osteoporos Int 15(6) 452-454... 

Lechin et al. 1996, Gray et al. 1999), but also increases the risk of falls and hip fractures (Passaro et al. 2000, Ray et al. 2000, Wang et al. 2001). Daily dose and longer duration of benzodiazepine use is associated with higher risk of fracture (van der Hooft et al. 2008). These fractures lead to great hospitalisation costs. In a European study it was estimated that costs of accidental injuries related to benzodiazepine use in the EU are between Euro 1.5 and Euro 2.2 billion each year. More than 90% of these costs were in the elderly with fractures as the major contributor (Panneman et al. 2003). 

Wang PS, Bohn RL, Glynn RJ et al. (2001) Hazardous benzodiazepine regimens in the elderly effects of half-life, dosage, and duration on risk of hip fracture. Am J Psychiatry 158(6) 892-898... 

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