When talking about health, some of the most present fears among older people have to do with diseases such as cancer or degenerative pathologies. But there is another fear that, apparently, should not be linked to death, and yet it is, very much so: hip fracture.
This concern is not born out of nowhere nor is it unfounded. In fact, it is fully justified by science, since recent studies such as the one carried out at the Zeeland University Hospital, Koege, in Denmark, point in that direction.
The Danish research involved 113,721 patients, and its authors observed that the risk of mortality at 30 days it was 9.6%; At 90 days, it rose to 16%, and reached 27% one year after IC surgery (acute intracapsular hip fracture).
Although, “a hip fracture is not usually the direct cause of death, it does act as a triggering event that precipitates a global decline in patients who already present frailty, chronic diseases o prior limitations«, points out Dr. Manuel Vides, Head of Orthopedic Surgery and Traumatology at Hospiten Estepona. The doctor emphasizes that «talking about hip fracture in elderly It is talking about a complex problem, where the orthopedic and the medical are intertwined.”
Therefore, the fracture is only the trigger. But a trigger with definitive health consequences of the one who suffers it. Furthermore, the risk increases significantly when several elements coincide.
Among the most important, the expert highlights “advanced age and previous fragility, the presence of chronic diseases (cardiovascular, respiratory, diabetes, dementia), poor nutritional status or very reduced muscle mass, delay in surgical intervention (especially if it exceeds 48 hours) and the existence of previous functional limitations or long periods of immobilization.”
When all these factors are combined, the fracture “can trigger a process that is difficult to reverse, marked by immobility, the appearance of medical complications and an accelerated loss of autonomy,” concludes the doctor.
What happens after a hip fracture?
At the point of origin, that is, at the moment the injury occurs, a process begins in which different complicationssome of them especially serious. «The combination of trauma, surgery and loss of functionality creates wear and tear that the body, especially at advanced ages, is sometimes unable to compensate for,» says the expert, who believes that most frequent complications They are infections, thromboembolic problems and loss of autonomy.
«Infections are an important source of risk. Lack of mobility makes it difficult to ventilate the lungs well and increases the likelihood of pneumoniawhile dependence on cleanliness and the use of urinary catheters increase urinary tract infections. When these processes worsen, they can lead to sepsis,” summarizes the doctor.
It is also common for problems such as deep vein thrombosis or pulmonary thromboembolism to appear. “Prolonged immobilization and the inflammatory state «After surgery, they encourage clots to form, which makes this complication one of the most feared,» the expert clarifies.
Added to all this is the loss of independence. “Many patients fail to recover the level of functionality that they had before the fracture, and this can translate into prolonged, or even permanent, dependence,” he warns.
Furthermore, “we must not forget that all physical and emotional stress which implies intervention can decompensate previous chronic diseases, which accelerates the general deterioration of health,” he concludes.
They have a worse prognosis
Although it is true that it is an evil that does not distinguish between men and women, it is also true that does not affect some in the same way and others. Specifically, women fracture more, but men die more after a hip fracture.
This is a well-documented phenomenon, which is because “men who fracture usually have more comorbidities undiagnosed or worse controlled,” clarifies Dr. Vides.
Furthermore, the doctor attributes this statistic to the fact that there are fewer preventive awareness in male bone healthso fewer cases of osteoporosis are diagnosed. “It is also important to highlight that they have worse functional recovery and a higher risk of postoperative complications,” he adds.
Once the causes and possible (and tragic) consequences are known, the idea is to put in place the necessary means to reduce the possibilities of reach the worst outcome. In this sense, “optimal management must be multidisciplinary and coordinated,” says the expert.
«The measures with the greatest demonstrated impact are several, although the importance of early surgery (first 24-48 hours) when medical conditions allow it must be highlighted; early mobilization, ideally in the first 24 postoperative hours; the antithrombotic prophylaxis and measures to reduce the risk of infections; specialized geriatric care, essential to control comorbidities; intensive and early rehabilitation, which is key to recovering functionality; and special attention to nutritional care, including supplementation when indicated,” details the doctor.
All the measures mentioned try to neutralize the effects of hip fracture. Now, also it is possible to go back a few years and implement a preventive strategy. “The most effective are related to the prevention of osteoporosis through densitometry according to age and risk factors, vitamin D and calcium consumption when indicated and pharmacological treatments in high-risk cases,” says the doctor.
In addition, regular physical exercise is of vital importance, especially “strength work to maintain muscle mass, balance training to prevent falls and moderate walking and aerobic activity,” he summarizes.
On the other hand, other tips to avoid a hip injury with a great impact on prevention would be, according to Vides, “the adaptation of the home, medication review and disease control and periodic geriatric evaluation, to early detect fragility, malnutrition or muscle deterioration.”
Eva Carnero
