Dementia, Prior Breaks Signal Hip Fracture Risk.

DENVER -- Nearly half of independent living patients who sustained a hip fracture bad a history of a previous fracture, Dr. Lorraine A. Fitzpatrick reported at the annual meeting of the Endocrine Society.

Cognitive impairment was another red flag for hip fracture risk. One-quarter of patients who fractured a hip had dementia or organic brain syndrome. Eleven percent experienced transient ischemic attacks, said Dr. Fitzpatrick of the Mayo Clinic, Rochester, Minn.

These findings, from a consecutive series of 110 community-dwelling patients admitted to the Mayo Medical Center with a hip fracture, identify important risk factors for this injury that can be targeted in clinical practice.

For example, fully 25% of patients had a known prior Colles' fracture of the wrist. Another 15% had a prior hip fracture. Add in a handful of prior vertebral, ankle, and pelvic fractures, and a total of 45% of patients had a known prior fracture.

Vertigo was a problem for 2% of patients before their hip fracture. Gait instability, functional gait problems, and focal cortical degeneration were even rarer. Most of these community-dwelling individuals had been quite active: Only 3% had been chair- or bedridden, and another 3% were inactive. Twenty percent were fully active and were brisk walkers, and the remainder were able to ambulate with ease at home or in the community.

The mean age of the study population was 71 years. Two-thirds were women. Only 20% of patients or their family members realized at the time of hip fracture that the patient had a diagnosis of osteoporosis.

Dr. Fitzpatrick emphasized the importance of early intervention in at-risk patients to avoid hip fracture and the marked disability that follows. Studies have shown that the all-cause mortality rate is 24% 12 months after a hip fracture, and a substantial proportion of survivors are no longer ...