The absolute number of hip fractures is large, increasing, and related to osteoporosis as well as other factors. By 65 years of age, 50% of women will exhibit bone mineral below the fracture threshold; by age 85, 100%. Trabecular bone loss, which occurs before cortical bone loss, is characteristic of postmenopausal osteoporosis, while cortical bone loss, which increases with age (especially after the age of 70), is characteristic of senile osteoporosis. Estrogen treatment is reasonable for early postmenopausal osteoporosis, less so for the senile variety. The elderly often lose the renal ability to 1-αhydroxylate 25-OH vitamin D and thus lose the ability to absorb calcium; they are refractory to D3 therapy, and may require more expensive therapy with 1,25-(OH)2-vitamin D. “Trivial” trauma with falls caused by loose rugs, electric cords, and the like may often be the primary cause of proximal femoral fractures. Sedative drugs are also hazardous. The polyfactorial problem of proximal femoral fractures requires treatment by a multidisciplinary medical team.
* Professor, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.