In the Western world, the lifetime risk for hip fracture in
women over the age of 50 years is 18-23% and by 2050, the worldwide
annual number of hip fractures is expected to reach 4.5 to 6.3 million,
reflecting the continuous ageing of the population.
Hip fractures are of great concern as they are the most severe type
of fracture in osteoporotic patients, associated with premature death,
and commonly leading to long-term physical disability, impaired capacity
to perform daily activities and live independently, and reduced quality
‘There is a need to explore complementary approaches to immediately prevent hip fractures in very high risk patients.’
Prevention of hip fracture is currently based on pharmacological
intervention together with regular physical activity, prevention of
falls, and correction of nutritional deficiencies, including vitamin D
repletion. However, the efficacy of the various measures to reduce hip
fractures is at most 50% and may need months or years before becoming
Additional challenges include the high treatment gap (even
among those who have already suffered a hip fracture) and that 50% or
more of patients who are on pharmacological treatment discontinue it
within a year. Clearly there are unmet needs for patients at imminent
risk of hip fractures that need to be addressed, including exploring
potential new approaches.
A new review authored by a European Society for Clinical and
Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal
Diseases (ESCEO)/International Osteoporosis Foundation (IOF) working
group has looked at the presently available approaches for prevention of
hip fracture and at potential future approaches to address unmet needs
in very high-risk patients.
The panel discussions concluded:
- There is a need to explore complementary approaches
to immediately prevent hip fractures in very high risk patients,
particularly following a first hip fracture.
- The challenges of current approaches include poor adherence
and the lag time in onset of fracture risk reduction with medications.
- A possible role of orthopaedic interventions in strengthening bone should be explored and discussed.
- Procedures to test may include prophylactic nailing,
femoroplasty with cement, and bone grafting with osteoconductive or
- Clinical studies aimed at demonstrating the benefits and
safety profile of surgical approaches are however challenging -
including the need to use clear surrogate markers for bone strength
improvement and identification of the level of high risk most likely to
benefit from the procedure.
- The frail elderly patient, who is the most likely to be in
need of, and benefit from, fracture prevention is also the most
susceptible to comorbidities, and pre- and post-surgery complications.
- Target patient and intervention thresholds for surgical
options remain to be established in the context of risk-benefit analysis
- overall, the benefits should be in line with the risks.
Professor René Rizzoli, lead author and Chair of the ESCEO Scientific
Advisory Board said, "Given the very serious, indeed life-threatening,
repercussions of hip fractures, we must do all we can to find effective
strategies for prevention, including in the frail elderly.
Notwithstanding the many challenges involved, the presently untapped
potential of preventive surgical interventions for patients at imminent
risk of hip fracture deserves further investigation by researchers in