Falls and fractures

The incidence of fractures of the hip, forearm, vertebra, humerus, pelvis and ankle increases with advancing age, but rises particularly rapidly after the age of 75 years [1]. The lifetime risk of symptomatic fracture for a 50-year-old white woman in the UK has been estimated to be 13% for the forearm, 11% for the vertebra, and 14% for the hip, whereas the corresponding figures for a 50-year-old man are 2%, 2%, and 3% respectively [2]. These fractures are a major cause of mortality, morbidity and health and social service expenditure in older people, but this is particularly the case with hip fractures. The excess mortality after hip fracture is 10–20% [2], but is generally higher in men than women. Up to 50% of patients become more dependent after hip fractures, many requiring placement in a residential or nursing home [3]. The annual cost of osteoporotic fractures in the UK has been estimated at £942 million, of which 87% is attributable to hip fractures [4].