Hip fractures are disasters of ageing!

Sarcopenia, osteoporosis and nutrition in older hip fracture patients

Background: Hip fractures are acute disasters of aging.

A hip fracture occurs when someone falls and the hip bone is not able to withstand the force when hitting the ground, resulting in a fractured bone. Patients who suffer hip fractures often suffer from osteoporosis and malnutrition. Malnutrition is associated with falls, ostopeorosis, and sarcopenia. Every year 0.8 % of women and 0.4 % of men above the age of 50 will suffer a hip fracture. In the year after hip fracture 21 % of women and 33 % of men will die. 4-5% of all deaths in the population are attributable to hip fractures. The incidence of hip fracture increases with increasing age and 5% patients in nursing homes in Bergen will suffer a hip fracture every year. An 80 year old women who suffers a hip fracture is at greater risk of death than an 80 year old women diagnosed with breast cancer, and has a far greater risk of becoming dependant on the help of others. In one study, 80 % of women said they would prefer to die rather than suffer a hip fracture with loss of independence. Sarcopenia is a geriatric syndrome of reduced physical performance, reduced strength and muscle mass. The prevalence increases with age and it is more common in men than in women. People with sarcopenia are more likely to die, become immobile, suffer falls and become dependent on others. Treatment of sarcopenia consists of physical exercise and treatment of malnutrition and optimal management of comorbidities. A large proportion of hip fracture patients suffer from sarcopenia.

Objectives: This project aims to investigate the relevance of sarcopenia in hip fracture patients. What is the prevalence? What is the association of sarcopenia with osteoporosis and malnutrition? Does sarcopenia predict adverse outcomes? How can one diagnose sarcopenia at the bedside?

Methods: Prospective observational study with 1 year follow-up at 3 hospitals in Norway. Patients were patients acutely admitted to Haraldsplass deaconess hospital, Haukeland university hospital and Diakonhjemmet hospital for surgical repair of hip fracture. Participants were included postoperatively while still in hospital. There was a follow-up examination after 3 months including a DXA scan and the third and final examination was an interview by phone 1 year after the hip fracture.

Results so far: Inclusion and follow-up are finished. 282 patients were included. The first article is accepted for publication “Identifying Low Muscle Mass In Patients With Hip Fracture: Validation Of Bioelectrical Impedance Analysis And Anthropometry Compared To Dual Energy X-Ray Absorptiometry”.

Preliminary conclusions: Bioelectrical impedance analysis and anthropometry are valid methods for identifying low muscle mass states in individual hip fracture patients or determining muscle mass in groups of patients, but do not have sufficient accuracy to replace DXA for determining muscle mass as a continuous measure in individual patients.