Prevention and treatment of medical conditions associated with hip fractures is critical as 50% of patients will have a second fracture within 3-5 years. Providers should evaluate calcium and vitamin D levels, screen for osteoporosis using dual-energy x-ray absorptiometry (DEXA) scan, prescribe calcium (1000-1500 mg/day) and vitamin D supplementation (400-800 IU/day) and bisphosphonates, encourage smoking cessation and yearly eye examinations, discuss alcohol use, and review medications to minimize issues with polypharmacy as well as other conditions, which increase fall risk.
Providers should encourage geriatric patients to participate in exercise programs that focus on balance and stability, such as Tai Chi, to reduce risk of falls, weight-bearing exercises to help increase bone density, and muscle strengthening to assist with transfers and ambulation.48,55 Patients would also beneht from continued physical therapy to improve gait stabilization, hexibility, and use of assistive devices. Environmental modihcations reduce risk of falls such as addition of grab bars in the bathroom, placement of skid mats, fortifying rails for stairs, having adequate lighting, and ensuring clear paths where patient ambulates (no loose carpets, rugs, and toys).51
Research has been initiated on the use of hip protectors (specially designed underwear with padding) for fracture prophylaxis with mixed results and on the efficacy of prophylactic hxation in patients at risk for contralateral hip fracture.56 57