CHARACTERIZATION OF PATIENTS WITH HIP FRACTURE ADMITTED TO A REHAB INPATIENTS

Introduction. Severe Osteoporosis is one of the major problems of elderly patients. Hip fractures are the most impactful event in terms of mortality and disability (1-2), requiring in many cases hospitalization in intensive rehabilitation department. The purpose of our study is to characterize the population of elderly with fragility hip fractures, admitted to a rehabilitative setting. Materials and methods. We enrolled 132 women, aged 60 years or older, with fragility hip fracture, admitted at a rehabilitation hospital “Clinic Center” in Naples, in a period between February and September 2011. We excluded women with fractures of the proximal femur secondary to malignancy (primary or metastatic) and with high degree of cognitive impairment. For all the recruited patients personal data, medical records, operating data and the post-intervention data, the assessment of walking ability in the 15 days preceding the fracture using the Functional Category Ambulation (FAC) and the assessment of cognitive status using the Short Portable Mental Status Questionnaire (SPMSQ) in the post-intervention were collected. All patients underwent X-rays of the dorsal-lumbar spine in the lateral plane for the assessment of vertebral deformities. Results. Our study population had a mean age of 80.46 years (min 60, max 94), with an average BMI of 25.36 (15.63 min, 37.34 max). The 23.85% underwent surgical menopause. The 4.55% of subjects were smokers, 17.42% drinkers. The family history of fragility fractures was positive in 17.42% of cases. The 25.18% of subjects had personal history of previous fractures over 50 years: in 12.21% of these cases previous fractures were represented by the fracture of the controlateral femur. Most of the enrolled patients (97.73%) had comorbidities and were taking several drugs. The 23.48% of patients had already performed therapies for osteoporosis and 45.45% performed these at the time of enrollment. Before the fracture, the 82.57% of patients were able to walk without assistance (FAC 3-5). The 36.36% of our patients presented normal mental functioning as assessed with the SPMSQ, the 28.79% presented mild cognitive impairment and 34.85% a moderate cognitive impairment. Spinal deformities were present in 60.61% of cases, with multiple deformities in 41,94% of cases. Conclusions. The presence of comorbidities and reduction of walking ability induce an increased risk of falling, with significant reduction in survival and quality of life in older adults. People with hip fracture had a high prevalence of fragility vertebral fractures. Comprehensive management, including rehabilitative treatment, is essential for an optimal outcome in terms of QALYs (Quality Adjusted Life Years) for elderly with hip fractures, especially for comorbid patients. Bibliography 1. Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a word –wide projection. Osteoporos Int 1992; 2(6): 285-9. 2. Piscitelli P, Brandi ML, Tarantino U, Baggiani A, Distante A, Muratore M et al. Incidence and socioeconomic burden of hip fractures in Italy: extension study 2003-2005. Reumatismo. 2010 Apr-Jun;62(2):113-8.