A guide to prevent & treat hip fractures in the elderly

hip- Cristina Gottardi
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Hip fractures

Each year, 1.6 million hip fractures occur according to the International Osteoporosis Foundation, increasing to 6.4 million by 2050, due the overall ageing of the population worldwide.[1,2]

Hip fractures are serious concerns associated with chronic pain, reduced or loss of mobility and increased dependency. [3] They can also lead to death, most commonly associated with difficulties with the recovery from post-op.  It is a healthcare burden with average cost per fall injury valued at $3611 in Europe and $1049 in Australia [4].

Hip fractures can be treated and prevented. In addition to traditional treatment, alternative medicine is also an option in maintaining bones health and repairing hip fractures in the elderly: let’s learn how.

hip pain

Causes of Hip Fractures

The main cause of a hip fracture are falls. Statistics show that falls are the second leading cause of accidental injury or deaths worldwide accounting for 424,000 deaths according to the 2016 WHO statistics.

Each year, 37.5 million falls occur worldwide that require medical attention. The incidence of falls is highest in adults age 65 and above. There are many causes of falls such as ageing, unsafe environments and medical conditions.

  • Ageing

Victims of falls and hip fractures are older people. With the onset of ageing, vision fails, making it difficult to see properly obstacles that might be in the way when walking, resulting to falls.[5]

Reflexes are also slower, making older persons hurt themselves when they fall. They react slowly to shield themselves from a bad impact of a fall, so that it is highly likely for injuries to happen.

In short, physical, sensory and cognitive perceptions change in older adults putting them at high risk for falls and injuries.[6]

  • Unsafe environments

Exposure to unsafe environments such as slippery surfaces, sliding and falling, are other major sources of falls and hip fractures. Older adults might also be exposed to hazardous working conditions such as elevated heights.
Side effects of medication, alcohol or substance abuse can also contribute to falls and subsequent fractures or injuries (WHO Fact Sheet, 2016).

  • Medical conditions

Broken bones are common in the elderly. As ageing occurs, the elderly is more prone to diseases of the bone. The bones are brittle and fragile such that they easily break even with a low-impact fall.

Osteoporosis is more common in women than men with 200 million worldwide affected by the disease.[7] It has an economic impact with sufferers confined to the hospitals due to the disease. Studies show women over 45 years spend more time at hospitals due to osteoporosis than other diseases such as breast cancer or diabetes.[8] It also affects mobility and independence.

Other conditions that can contribute to fragile bones, making them susceptible to breaking. include cancer or stress injuries.[9]

What Happens When the Elderly Fall

Broken hips or serious injuries to the hip are major consequences of falling.

Once admitted in the hospital, the doctor evaluates the medical and health condition of the patient. Unless the patient is suffering from terminal pathologies, an operation is, in most cases, recommended quickly.

Surgery for hip fractures is advised within 24 hours. The rationale behind early treatment is to reduce bed confinement and associated complications.  [10]

Treatment

Surgical treatment involves using general anaesthesia and antibiotics (at least pre and 24 hours post-surgery). Blood & urine tests, ECGs and chest X-rays will also be performed.

Surgical procedures that will take place depend on the broken area.

http://www.aafp.org/afp/2003/0201/afp20030201p537-f3.jpgFor example, if it is broken the head of the femur or the ball, the operation will consist of fixing the cartilage on the injured area.

For interacapsular hip fractures, the surgeon can fix it by individual compression hip screws to stabilize the broken part.

Intertrochanteric fractures are fixed with hip screws or nails while subtrochanteric injuries are managed with nails, screws and plates (AAOS, 2009).[11]

Among older patients, the damage to the head of the femur may be greater. In these cases, medical intervention includes replacing some of the components of the hip.

This can imply several things: replacement of the ball, both ball and socket or the head of the femur and cetabulum. [14]

Recovery

After surgery, rehabilitation is the primary concern of medical practitioners so that the patient regains mobility.

The other less pleasant side to surgery and hip fractures is that a good percentage of victims do not recover at all from their falls. According to the 1993 studies by Madhor et al and Schroder et al, 5-10% of hip fracture patients experience recurring problems with an interval of 3.3 years. Morbidity rates are from 20-24% in the first year after breaking hips. The risk of dying will persist for at least 5 years. [14] [15] The most devastating impact is the loss of independence and functioning with 40% unable to walk by themselves and 60% of survivors requiring help after a year.[16] In this scenario, nursing care is highly needed (33% are dependent) and the patient will have to rely on other people for their day-to-day needs.[17] [18] [19]

  • Physical therapy

    Begins usually a day after the procedure depending on the extent of the operation. [13] In some cases, patients need a little more time to recover from the physical aspect of surgery  before any PT can begin. However, the consensus is to start PT as soon as possible for a speedier recuperation of mobility.
    It is highly recommended to initiate physiotherapy by means of massage and manipulation.
    The 2009 study of Kreder states that starting weight bearing immediately minimizes hospital stays, complications and morbidity.

  • Myrcene and CBD can help mend bones quicker

    The benefits of medical marijuana not only apply to certain diseases such as cancer, PTSD, seizures and others, but may also assist in healing bones after hip injuries occur. More research needs to be done in this area, but this is a promising news that can help hip injuries heal qNature Going Shopuicker, disrupt displacement minimally and recover mobility in a shorter period even after surgery.
    A Tel Aviv University and Hebrew University study found out that when cannabinoid cannabidiol (CBD) was administered to rats with mid-femoral fractures, healing was enhanced in just 8 weeks. In an earlier research, it was discovered that the human body’s cannabinoid receptors can promote bone development and prevent bone loss. [12]

    Cannabidiol stimulates osteoblasts, bone cells involved in collagen stabilization, thereby increasing bone mass during the healing process and minimizing the likelihood of fracture in the future.

    Myrcene is one of the most abundant essential oils produced by the cannabis plant. It has been shown consistently to generate anti-inflammatory effects. Myrcene’s anti-inflammatory properties seem to play a significant role in chondrocytes, as demonstrated by a study of Rufino.
    The experiments showed that this particular molecule can slow down and even halt cartilage destruction in a model examining osteoarthritis. [22]

hip https://eldergym.com/wp-content/uploads/2014/01/elderly-balance-2b.jpg
Prevention

Hip fractures may be prevented. Although there is nothing one can do about ageing, its normal decline can be slowed down. Staying healthy is key to preventing falls. This means going regularly for medical exams to can detect vision problems, bone loss or muscle coordination issues and even other debilitating diseases.

  • Exercise

Another important factor is to make exercise part of daily or weekly activities. The Department of Health and Human Services and the National Health Services suggest 150 minutes of moderate or 75 minutes of vigorous activities or a combination of both in a week. Everyone must move to prevent the onset of diseases.  It is especially vital among seniors where normal ageing can already affect physical and cognitive functioning.
Yoga and yogic breathing exercises can help people of all ages to keep their physical and mental body healthy, to move without strain and to increase flexibility, coordination and reflexes. We recommend you check out this yoga sequence to start out with.

  • Diet

Diets are also important in the elderly. Attention must be paid to recouping bone loss through ageing. Diets rich in vitamins D and calcium can reduce the risk of getting osteoporosis (National Osteoporosis Foundation).[20] If calcium and vitamin D are not sourced adequately from meals, taking supplements can help develop better bone health.
Thus, when seniors fall, damage to the bones are limited when they are strong. In addition, healing of bones is faster when there is good bone health.
hip fractures https://s-media-cache-ak0.pinimg.com/736x/66/52/0d/66520d71abdfab992870bfb1187ba436.jpg
Great sources of calcium foods are: red cabbage, white beans, dried figs, kale, almonds, oranges; Whilst Vitamin D can be absorbed and produced with adequate exposure to sunlight.

Check out these recipes: “Jackfruit & bone health” and “Vegan lasagne for optimal bones health”

Glucosamine is a compound that is naturally made in humans. It is involved in the creation of molecules that form cartilage. Integrating with supplements has shown promising effects in patients with many conditions, such as osteoarthritis, and has also been studied for possible benefits on acceleration of wound healing . [23]

  • Fall-proofing surfaces and living spaces

Making home environments safe for the elderly or for everyone can also reduce falls and slipping drastically. Adapting living spaces to the needs of older people or those with limited mobility can assist in reducing or preventing falls. Installing grab bars in bathrooms and non-skid mats are examples along with handrails for stairs and putting lights in dim areas such as halls, stairs and corridors. Improving visibility of low lit areas can help the elderly move around without restrictions and fear of tripping, slipping or falling.

Outlook

Hip fractures can have devastating effects physically, emotionally and financially. Loss of independence and mobility is the biggest detrimental consequence of fractures. Dependence on other people can also put a heavy toll on the emotional and psychological condition of patients resulting to anxiety and depression.[21]

Putting in place preventive measures can help reduce the probability of hip fractures amongst the elderly.

These include improving lifestyles, maintaining normal ageing and re-purposing homes. With careful planning, there is no reason why seniors cannot have a normal, dignified and independent life without putting stress on their finances due to soaring medical or nursing care bills.

This article has been written with the contribution of Jessica Walter.

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References

[1] Gullberg B, Johnell O, Kanis JA. (1997) World-Wide Projections for Hip Fracture.  Osteoporos Int. 7(5):407-13.

[2] Cooper C, Campion G, Melton LJ, 3rd (1992) Hip Fractures in the Elderly: a World-Wide Projection. Osteoporos Int 2(6):285-9.

[3] Keene GS, Parker MJ, Pryor GA. (1993) Mortality and Morbidity After Hip Fractures. BMJ 307:1248.

[4] Falls Fact Sheet. (2016) World Health Organization.

[5] Schmall, Vicky L. (2000) Sensory Changes in Later Life. Oregon State University.

[6] Papalia Diane E., Wendkos Olds Sally, Duskin Feldman Ruth. (2006) Physical and Cognitive Development in Late Adulthood.

[7] Kanis JA. (2007) WHO Technical Report, University of Sheffield, UK: 66.

[8] Kanis JA, Delmas P, Burckhardt P, et al. (1997) Guidelines for Diagnosis and Management of Osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporos Int 7:390.

[9] (2009) Hip Fractures. American Academy of Orthopaedic Surgeons.

[10] Simunovic N, Deveraux PJ and Bhandari Mohit. (2011) Surgery for Hip Fractures: Does Surgical Delay Affect Outcomes? Indian J Orthop. Jan-Mar; 45(1): 27–32.

[11] (2009) Hip Fractures. American Academy of Orthopaedic Surgeons.

[12] Kogan, Natalya M., et al. “Cannabidiol, a Major Non‐Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts.” Journal of Bone and Mineral Research 30.10 (2015): 1905-1913.

[13] (2016) Hip Fracture Recovery. National Health Service.

[14] Cooper C, Atkinson EJ, Jacobsen SJ, et al. (1993) Population-based Study of Survival After Osteoporotic Fractures. Am J Epidemiol 137:1001.

[15] Leibson CL, Tosteson AN, Gabriel SE, et al. (2002) Mortality, Disability, and Nursing Home Use for Persons with and without Hip Fracture: a Population-Based Study. J Am Geriatr Soc 50:1644.

[16] Magaziner J, Simonsick EM, Kashner TM, et al. (1990) Predictors of Functional Recovery One Year Following Hospital Discharge for Hip Fracture: A Prospective Study. J Gerontol 45:M101.

[17] Leibson CL, Tosteson AN, Gabriel SE, et al. (2002) Mortality, Disability, and Nursing Home Use for Persons with and without Hip Fracture: A Population-Based Study. J Am Geriatr Soc 50:1644.

[18] Magaziner J, Simonsick EM, Kashner TM, et al. (1990) Predictors of Functional Recovery One Year Following Hospital Discharge for Hip Fracture: A Prospective Study. J Gerontol 45:M101.

[19]  Kannus P, Parkkari J, Niemi S, Palvanen M (1996) Epidemiology of Osteoporotic Ankle Fractures in Elderly Persons in Finland. Ann Intern Med 125:975.

[20] 2017) Calcium/Vitamin D. National Osteoporosis Foundation.

[21] Williamson GM and Schulz R. (1992) Pain, Activity Restriction, and Symptoms of Depression Among Community-Residing Elderly Adults. J Gerontol.47(6):P367-72.

[22] Rufino, Ana Teresa, et al. “Evaluation of the anti-inflammatory, anti-catabolic and pro-anabolic effects of E-caryophyllene, myrcene and limonene in a cell model of osteoarthritis.” European journal of pharmacology 750 (2015): 141-150.

[23] Kanzaki, N., Saito, K., Maeda, A., Kitagawa, Y., Kiso, Y., Watanabe, K., Tomonaga, A., Nagaoka, I., and Yamaguchi, H. Effect of a dietary supplement containing glucosamine hydrochloride, chondroitin sulfate and quercetin glycosides on symptomatic knee osteoarthritis: a randomized, double-blind, placebo-controlled study. J Sci Food Agric. 3-15-2012;92(4):862-869.

Viola Brugnatelli

Viola Brugnatelli is a Neuroscientist specialised in Cannabinoid circuitry & GPCRs signalling. Her academy and research training let her gain extensive experience on medical cannabis and terpenes both from preclinical as well as clinical perspective. In her vision, collective human knowledge behold the power for overall improvement of life, thus, it should be accessible and shareable. Viola is Founder of the science online magazine Nature Going Smart, and works as a consultant for companies & individual patients, as a speaker at seminars and workshops and as a lecturer in a CME course on Medical Cannabis in Italy, at the University of Padua.

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3 Responses

  1. Ian smith says:

    Another good article however I believe some very relevevant things were left out regarding bone strength and health. I implore your readers to read the borax conspiracy by Walter last and articles by Rex newnham on boron, Rex a plant scientist discovered that lack of boron was the cause of most people’s arthritis and that it was an essential element, prior to his discovery it was not considered necessary for human health. Not only was it necessary it was soon realised that it was not only bone but male and female hormones in estrogen and testosterone that were regulated by it. More recently it is highly suspected to be a lack of boron that causes some Cancers.along with magnesium and silicon I suggest are the reason for soft fragile bones. As 70 percent of people are magnesium deficient and most with arthritis are boron deficient, those with worn cartliage in joints add sulphur to the above. It amazes me that doctors are still recommending calcium to people especially post menopausal women when this has been totally discredited.

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