Post-fracture management of patients with hip fracture: a perspective^*

ABSTRACT

Background: Hip fracture creates a worldwide morbidity, mortality and economic burden. After surgery, many patients experience long-term disability or die as a consequence of the fracture. A fracture is a major risk factor for a subsequent fracture, which may occur within a short interval.

Methods: A literature search on post-fracture management of patients with hip fracture was performed on the Medline database. Key experts convened to develop a consensus document.

Findings: Management of hip-fracture patients to optimize outcome after hospital discharge requires several stages of care co-ordinated by a multidisciplinary team from before admission through to discharge. Further studies that specifically assess prevention and post-fracture management of hip fracture are needed, as only one study to date has assessed an osteoporosis medication in patients with a recent hip fracture. Proper nutrition is vital to assist bone repair and prevent further falls, particularly in malnourished patients. Vitamin D, calcium and protein supplementation is associated with an increase in hip BMD and reduction in falls. Rehabilitation is essential to improve functional disabilities and survival rates. Fall prevention and functional recovery strategies should include patient education and training to improve balance and increase muscle strength and mobility. Appropriate management can prevent further fractures and it is critical that high-risk patients are identified and treated. To foster this process, clinical pathways have been established to support orthopaedic surgeons.

Conclusion: Although hip fracture is generally associated with poor outcomes, appropriate management can ensure optimal recovery and survival, and should be prioritized after a hip fracture to avoid deterioration of health and prevent subsequent fracture.

Key words: :

• Hip fracture
• Optimal management
• Postoperative care
• Rehabilitation

Acknowledgements

Declaration of interest: This article is based on the outcomes of a Working Group meeting convened on 18 April 2008, by the European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), a non-profit organization. ESCEO sponsored the publication of this article. Some of the authors have received support from, and/or, have given talks, attended conferences and participated in trials and advisory boards sponsored by various pharmaceutical companies. The authors confirm that no pharmaceutical company was involved with the drafting and publication of this article, financially or otherwise.

ESCEO provided financial support for editorial assistance provided by Elinor Washbrook, BioScience Communications, London, UK. All authors take full responsibility for the contents of the article and have read and approved the final draft.

Notes

* This article is based on the outcomes of a Working Group meeting convened 18 April 2008, by the European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), in Cannes, France. The Working Group was co-ordinated by Prof. Steven Boonen