March 15th, 2010
05:00 PM ET
By Saundra Young
Editor's note: In a previous version of this post, the form of zoledronic acid that reduced death rates by 28 percent over a three-year period was inaccurately identified. The correct form of the drug is Reclast
Hip fractures. They're breaks in the upper part of the femur or thigh bone, most often caused by a fall. People 65 and older are most vulnerable, and according to the American Academy of Orthopedic Surgeons, women have two to three times as many fractures as men. But a new study in the Annals of Internal Medicine says men are at greater risk of dying because of it.
Researchers looked at 39 studies involving nearly 600,000 women and 155,000 men over the age of 50, with hip fracture. They found that while older women are nearly six times more likely to die after a fracture than a woman without a break, older men are about eight times as likely to die in the first three months after their injury.
"Hip fractures are associated with a substantially increased risk of death for both men and women which lasts for at least 10 years after the fracture," said Dr. Cathleen Colon-Emeric, one of the study authors at Duke University Medical Center in Durham, North Carolina. "This highlights the importance of interventions which reduce operative complications and the physical decline that frequently results from a hip fracture."
Researchers are not quite sure why the risk of death increases. But Colon-Emeric says hip fracture is a major blow to your body. "People with hip fractures tend to be more frail. Many have underlying medical problems that put them at higher risk of death, like stroke, Parkinson's disease and dementia."
Earlier studies found that after a hip fracture men are more likely than women to die of infectious conditions such as sepsis and pneumonia.
Only 25 percent of these fractures occur in men. Dr. Jay Magaziner, chairman of the Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland in Baltimore, and a study co-author, says if you project forward to 2050, there will be as many hip fractures in men as there are currently in women today. "We know that men who fracture their hip are generally a bit sicker. They have more medical conditions at the time of their fracture than women. One of the reasons that we believe that is the case, is the natural process of aging post-menopausally in women."
Magaziner says the combination of falling and weak bones will create a hip fracture. He says women lose a little bit of bone each year after menopause, but men don't lose bone naturally. In fact, in order for men to lose enough bone to have a break when they fall, they generally have to have an underlying medical condition. "Women who fracture don't have these other medical problems, so that may be one of the reasons that we're seeing a higher mortality rate in men than women."
Dr. Sandra Fryhofer, an Atlanta, Georgia, internist and past president of the American College of Physicians, says the study is a wake-up call that men can get osteoporosis too. "It stresses the importance of prevention, making sure people are getting calcium, vitamin D and weight-bearing exercises like walking. Anything that puts weight on the bones, because that stimulates new bone formation."
Because men have not received a lot of attention on hip fracture and osteoporosis, Magaziner is working on new research to try to better understand the disparities. "If we can understand the differences in the way men and women respond to having a hip fracture then we can tailor our treatments to these differences and the way people recover," he said. "We want to individualize the way we treat patients."
Colon-Emeric says one treatment has proved to reduce mortality after fracture, an osteoporosis drug zoledronic acid or Reclast. It's made by pharmaceutical giant Novartis and new data show it reduced death rates by 28 percent over a three-year period. It's given once a year intravenously in a doctor’s office and it reduced the chance of additional fractures by 20 percent in a two-year period. Promising, because statistics show one in five will re-fracture their hip.
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