Pharmacologic and Non-pharmacologic Strategies to Prevent Hip Fracture in Old Age

Strategies for the prevention of hip fracture should focus on the frequency of falling as well as on the prevalence of compromised femoral integrity as a consequence of bone loss. Given the high prevalence of falls among the elderly, a performance-oriented functional assessment should be targeted at all patients over 75 years of age. As the risk of falling increases with the number of risk factors, risk may be reduced by modifying even a few contributing factors. Intervention studies have indicated the need to provide adequate supply of both calcium (1500mg daily) and vitamin D (400–800 IU daily) in old age, particularly in housebound elderly and nursing home residents. Bisphosphonate treatment reduces the risk of hip fracture among elderly women with confirmed osteoporosis but is not more effective than calcium and vitamin D alone in women identified primarily on the basis of risk factors other than low BMD.