Introduction
Osteoporotic hip fractures cause significant burden to the patient and healthcare system but are primarily considered an elderly issue. Data is lacking comparing demographics and risk factors of neck of femur (NOF) fractures in younger versus older populations. A clear understanding of these factors would facilitate an early and targeted approach in aggressive fracture prevention in high-risk individuals.
Method
Patients who had minimal impact NOF fractures at Westmead Hospital in the past year were included and groups divided at 70 years of age, the cut-off for geriatric care at Westmead Hospital. Data regarding their demographics, risk factors, bone mineral density (BMD) scans and outcomes were compared.
Results
Participants included 31 younger and 26 older patients. There was a greater proportion of males in the young NOF group (48% versus 42%). Smoking and alcohol abuse was more prevalent in young patients (38% versus 19%; 23% versus 12% respectively). Young NOF patients were more likely to have a history of previous fractures (45% versus 27%). There were similar proportions of vitamin D deficiency and other risk factors across both groups. The mean femur BMD was 0.71g/cm2 and T-score was -2.24 for young patients compared to 0.75g/cm2 and -2.47 for older patients (p=0.68 and p=0.80) with mean FRAX risk of osteoporotic fracture 4.8% and 17.1% respectively (p=0.37). All patients underwent surgery, but the average length of stay was 14.8 days for younger patients and 24 days for older patients with more older patients having reduced (68% versus 85%).
Conclusion
This retrospective review indicates that smoking and alcohol excess predispose to the development of NOFs in younger patients who likely have a critical degree of bone fragility as evidenced by previous fracture. Specific strategies to mitigate the risk of hip fracture in this group of patients is underway.