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Friday, March 17, 2000

Academy statement on prevention of hip fractures

Hip fracture disease, one of the most serious consequences of osteoporosis, is occurring at an epidemic rate in North America. There are 350,000 hip fractures annually in the United States. This number is increasing, with an expected incidence of 650,000 annually by the year 2050. The current annual cost is more than $9.8 billion, and increasing, at a time when control of health care costs is especially vital. Ninety percent of hip fracture patients are 65 years of age or older. For most patients and their families, a hip fracture is a devastating event, resulting in a host of potential medical problems, such as increased mortality, reduced mobility, and, for many, the inability to live independently. Hospitalization for the surgical treatment of hip fractures is routine. This diagnosis accounts for more hospital days, by far, than any other musculoskeletal injury, and represents 44 percent of all hospital days due to fractures.

The American Academy of Orthopaedic Surgeons believes that the growing epidemic of hip fractures requires a comprehensive national response, stressing education, prevention, and research.

Public education programs must raise the level of awareness concerning this serious public health problem. Also, these programs should focus attention on currently available techniques for prevention of hip fractures.

Organized prevention programs must involve both health care providers and the public. Emphasis should be directed toward reducing the incidence of severity of osteoporosis, as well as reducing the frequency and consequences of falls among the elderly. Advanced osteoporosis often can be prevented by sufficient calcium and vitamin D intake beginning in childhood, appropriate exercise throughout life, avoidance of smoking and excessive drinking of alcoholic beverages, and, when medically indicated, use of estrogen replacement, selective estrogen receptor modulator (SERM), a biophosphonate or calcitonin. Falls may be due to avoidable side effects of medication, to correctable gait and balance disorders, to impaired vision, or to environmental hazards. Protective padding might reduce the risk of fracture for individuals who are at risk of falling.

Orthopaedic surgeons recognize that efforts to reduce the number of hip fractures in America will be successful only with collaboration and cooperation with other allied medical specialties including primary health care providers. The American Academy of Orthopaedic Surgeons has joined with other groups, such as the National Osteoporosis Foundation in a Position Statement on Osteoporosis, to provide educational materials and support of programs to reduce the frequency of hip and other fractures.

Focused research is required to determine the most effective and least costly ways of preventing osteoporosis and fracture-causing falls. Research also is needed to determine the optimal treatments for hip fractures. Emphasis must be placed on maximizing functional outcome, avoiding medical and surgical complications, and developing systems and protocols for effective rehabilitation

The American Academy of Orthopaedic Surgeons supports the efforts of the U.S. Centers for Disease Control and Prevention; National Institute of Arthritis and Musculoskeletal and Skin Diseases; and National Institute on Aging to stimulate greater understanding of hip fracture, and urges allocation of further governmental and private support for research and education targeted at reducing the burden posed by hip fractures, the costliest of musculoskeletal injuries. This investment will help significantly to reducing the financial burden of health care for all Americans.

This statement is endorsed by the National Osteoporosis Foundation.

July 1993
October 1999

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Last modified 24/February/2000 by IS