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Hip Fractures Based on a Plenary Symposium “The Hip Fracture Epidemic” PowerPoint Presentation
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Hip Fractures Based on a Plenary Symposium “The Hip Fracture Epidemic” Chairs: Dennis Black, Bess Dawson-Hughes Speakers: Mary Bouxsein, Tamara Harris, Steven Cummings Saturday, October 16, 2010 ASBMR 2010 Toronto, Ontario. Incidence and Cause of Hip Fractures.

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Hip Fractures
  • Based on a Plenary Symposium
  • “The Hip Fracture Epidemic”
  • Chairs: Dennis Black, Bess Dawson-Hughes
  • Speakers: Mary Bouxsein, Tamara Harris, Steven Cummings
  • Saturday, October 16, 2010
  • ASBMR 2010
  • Toronto, Ontario
incidence and cause of hip fractures
Incidence and Cause of Hip Fractures
  • Due to the aging population, hip fracture incidence is expected toincrease 2- to 3-fold by 2050.
  • Facts:
  • • 90% of hip fractures are due to a fall
  • • 50% of those who sustain a hip fracture do not have osteoporosis (OP) on BMD testing
  • • A fall to the side is 6x more likely to produce a hip fracture
  • • In a fall, the femur is 3.5x weaker than in a walking or standing configuration
  • • Bone loss sustained with age makes people even more vulnerable to a sideway fall
  • • 1 in 5 people die within the first year after a hip fracture
  • • 50% of people do not return to their independent living situation if they were independent prior to the hip fracture
  • • 50% of people will not walk independently if they were walking independently prior to the hip fracture
  • • Psychological outcomes following a hip fracture are poor
in the western world
In the Western World
  • • Many countries in the West have seen a fall in the incidence of aged-standardized hip fracture rates in the last 10 or so years
  • • Rates in Denmark, Sweden and Norway have fallen by about 20% since about 1997
  • • In the US, age-standardized hip fracture rates have fallen by about 25% in women and 20% in men since 1995
sof study of osteoporotic fractures data on 80 to 84 year olds
SOF (Study of Osteoporotic Fractures): Data on 80- to 84-year-olds
  • • Between 1992 and 2002, hip fracture risk decreased by approximately 23%
  • • Femoral neck BMD increased substantially in the same age group
  • • Between 1992 and 2002, weight gain, greater estrogen and bisphosphonate use, and significantly greater use of vitamin D and calcium may also explain hip fracture risk decline
  • OP therapies in the US:
  • • In women, they account for 9% at most of the ~25% decrease in hip fracture rates
  • • In men, they account for very little of the 19% decrease in hip fracture rates
  • • In the SOF, increasing use of OP treatments could account for ~25% of the decline in hip fracture rates
hip fractures in the east
Hip Fractures in the East
  • In the early 1990s, age-specific hip fractures rates in Beijing, China, were about one-sixth or less than those in US Caucasians.
  • Approximately one decade later, age-specific hip fracture rates in women in Beijing have increased 3- to 4-fold, even though obesity rates are also rising.
  • Cultural Changes and Hip Fractures
  • • Use of cars over biking and walking has increased >4-fold since the early 1990s
  • • Citizens have moved from older residences where there were fewer chairs and no sofas to more Western-style apartments
  • • Squatting, which improves leg muscles and balance, was universal whereas now it is less common
  • • The incidence of hip fractures appears to rise with urbanization  
sarcopenia
Sarcopenia
  • Sarcopenia is the age-related loss of skeletal muscle mass
  • • In women, prevalence increases with age; in men, the prevalence increases to about the age of 50, after which it remains relatively stable
  • • Women with a history of hip fracture have a high prevalence of sarcopenia
  • • A reduction/increase in muscle weight = a corresponding loss/increase of bone
  • • One consequence of muscle loss is the risk of falling and subsequent fracture
  • OP and Sarcopenia
  • After adjustment for age and interval between fracture and DXA scan, a significant association between sarcopenia and OP was observed (P=0.026).
  • Adapted from Di Monaco et al. Arch Gerontol Geriatr 2010 Mar 4.Epub ahead of print.
deconditioning and aging
Deconditioning and Aging
  • Deconditioning due to inactivity (bed rest) has a powerful effect on function and physical activity
exercise in the elderly
Exercise in the Elderly
  • Ten weeks of progressive resistance exercise training and nutritional supplementation in very frail elderly patients (age =87 years) led to:
  • • Increased walking speed
  • • Increased stair-climbing ability
  • • Increased spontaneous activity
  • • Decrease in depressive symptoms
  • Skeletal muscle mass is the strongest independent factor associated with femoral neck BMD in men and women
future perspectives
Future Perspectives
  • Myostatin and muscle loss:
  • • As a negative regulator of muscle growth, increasing levels of myostatin cause muscle loss
  • • Myostatin probably affects bone as well
  • • Future drugs that neutralize or eliminate myostatin may have appositive effects on muscle and bone