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Posted: September 03, 2008

Elderly Run Very High Risk of Fractures after Hospitalization

The elderly who are hospitalized are three times as likely as others to suffer a bone fracture within a year of release, according to researchers who say their discovery should provide an attractive test bed to actually reduce the risk in the future.

"Hospitalization is an unrecognized opportunity to assess and reduce the risk of fractures in a very large number of elderly women and men," researchers from the University of California, San Francisco, reported in the journal Archives of Internal Medicine.


The UCSF research team linked the high incidence of post-hospitalization fractures in the Health Aging and Body Composition Study, funded by the National Institute of Aging.


Dr. Rebekah L. Gardner led a research team that studied 3,075 men and women between the ages of 70 and 79. The initial research was conducted in 1997 and 1998. All participants could walk a quarter of a mile, climb 10 steps, and perform activities of daily living without difficulty when the study began.


During an average follow-up of 6.6 years, 66% of the study participants were hospitalized and 26% were admitted three or more times. From this universe, 285 individuals suffered 362 fractures after discharge. These included 80 hip fractures in 74 seniors.


Gardner noted that the risk of fracture was greatest during the first year after hospitalization, with a risk of 3.4%. The risk of any fracture increased with the number of times a patient was hospitalized, from 1.38 after one admission to 3.17 after three or more hospital stays.


"Because the risk of fracture is greatest soon after hospital discharge, assessment and interventions to reduce risk should be started during the hospital stay or shortly after discharge," the UCSF team wrote, adding that evaluations should include measurement of bone mineral density, an assessment of the risk of falling, and testing to determine reduced-vision impact, if any.


Regardless, Gardner said, appropriate post-hospitalization treatment for the elderly should include calcium and vitamin D supplements; bisphosphonate drug treatment, such as alendronate (branded Fosamax) or risedronate (Actonel); vision correction if needed; and physical therapy, which should include walking programs and exercises to improve flexibility, strength and balance.

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