Neck of femur (NOF) fractures are a predominant cause of hospitalisation among people over the age of 65. They result in an end to independent living for 60% of those affected and death within six months from surgery for 30%. One major reason for both the occurrence of NOF fractures and their high mortality is malnutrition, according to a new study presented today at the 12th Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) in Copenhagen. A leading author of the study, Stefan Bajada (Princess of Wales Hospital Bridgend, Wales, UK), says that in order "to reduce the number of NOF fractures in general and to minimise complications during and after surgery, including death, we need to tackle malnourishment vigorously, both at the level of primary care and in hospital."

Most neck of femur fracture patients are malnourished

The study included 300 patients with neck of femur fractures and another 100 patients living at home who had not sustained fractures but who were pre-assessed for total hip replacement. It assessed mortality rates, three parameters for nutritional status such as serum protein, albumin and total lymphocyte count levels, as well as haemoglobin levels before and after surgery. A drop in haemoglobin indicates a loss of blood during the operation. The results showed significantly lower protein, albumin and lymphocyte counts in the fracture patients compared to the group without fractures. Among the fracture patients, the study also showed that in terms of generally recognised lower limits for sufficient nourishment, 66% fell short of the lymphocyte levels, 21% of the albumin levels and 10% of the protein levels. "These results confirm that malnourished elderly run a dramatically increased risk of fracturing their neck of femur, usually by falling due to a lack of strength," Mr. Bajada concluded.

Increased risk of bleeding - and dying

Not only is malnutrition associated with a higher risk of breaking one's bones. Among those with neck of femur fractures, the degree of malnourishment helped predict the likelihood of bleeding and even death during and after surgery. "A lower level of albumin and protein was clearly associated with a higher rate of intra- and post-operative haemoglobin drop, a clear sign of a higher bleeding tendency among the malnourished. And lower levels in any of the albumin, protein and lymphocyte counts resulted in an increased mortality risk within 6 months after surgery," Mr. Bajada told the EFORT Congress.

Early identification of the malnourished can save bones and lives

"These findings show that malnourishment is a momentous condition in the elderly. We need to be aware of it and to tackle it at all possible stages," Mr. Bajada warned. "Identifying malnutrition early, at primary care level, and then consistently treating it will likely prevent neck of femur fractures from occurring. Identifying the problem immediately after the patient's admission to hospital enables surgeons to take precautionary measures against the greater tendency of the malnourished to lose more blood than others. Finally, aggressively treating malnourishment during hospitalisation will reduce the patients' risk of dying soon after returning home."

Source:
European Federation of National Associations of Orthopaedics and Traumatology (EFORT)