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Osteoporosis Not To Blame For Most Hip Fractures In The Elderly

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Most hip fractures in elderly people are caused by falls and have little to do with osteoporosis, according to a study published in the British Medical Journal.

The analysis – titled “Overdiagnosis of bone fragility in the quest to prevent hip fracture” – suggests that taking medication to prevent hip fractures is neither viable as a public health strategy nor cost effective.

An international team of researchers led by Professor Teppo Järvinen from the University of Helsinki in Finland studied the efficacy of anti-osteoporotic medication in preventing hip fractures by reviewing all publications on the topic. These reports represent the scientific basis of the current treatment strategy.

The researchers concluded that the idea of preventing hip fractures with anti-osteoporotic medication is fundamentally flawed, because the brittleness of the bones does not significantly affect the occurrence of bone fractures among older people.

“Hip fractures are the result of falls or similar small accidents. Even if the older person has brittle bones, they are unlikely to fracture without an accident. Asking questions about balance disorders provides a more accurate understanding of the patient´s risk for bone fracture than taking bone density measurements,” Järvinen said.

According to the researchers, overdiagnosing the risk of fracture and the resulting overtreatment is bad for both patients and the healthcare system. As well as the side effects of osteoporosis drugs, there is a psychological impact from being labelled “at risk” – and fear of fractures can cause the patient to stop engaging in exercise, which in turn worsens health, they pointed out.

Evidence on the cost effectiveness of drug treatment is completely lacking, the authors said. Meanwhile, a focus on drug treatment means that other factors that contribute more significantly to the risk for fractures are easily overlooked, such as smoking, exercise, and solutions that may prevent falls.

Rates of hip fracture have fallen steadily in most Western countries, regardless of access to drugs.

http://www.eurekalert.org/pub_releases/2015-05/uoh-hfi052715.php

http://www.bmj.com/company/wp-content/uploads/2014/07/bon-fragility.pdf

http://www.bmj.com/content/350/bmj.h2088