Falls and hip fractures are common conditions among older people with
Alzheimer’s disease (AD) and are associated with high risk of morbidity and mortality.
People with AD have up to an 8-fold increased risk of falling and 3-fold higher risk of
hip fractures, compared with those who are cognitively intact. The increased risk of hip
fractures among people with dementia may occur through a few pathways, including
(a) risk factors that are common to both conditions, (b) the presence of dementia
increasing incidence of hip fracture through intermediate risk factors such as falls and
osteoporosis, and (c) side effects of treatment used in AD increasing hip fracture risk.
A better understanding of these mechanisms and their effects on outcomes after hip
fracture will assist in developing effective interventions and improving preventive
strategies. Population aging heightens the need to recognize the interactions of these
conditions in order to improve efforts to prevent hip fractures, improve outcomes
through high-quality acute care and rehabilitation that returns patients to premorbid
level of functioning, and provide evidence-based secondary prevention of falls or
fragility fractures. Acute care of hip fractures focusing on orthogeriatric comanagement
has been shown to reduce length of hospital stay, perioperative
complications including delirium, readmission rate and premature mortality. Secondary
prevention of falls and further fractures is essential by ensuring risk factors for falling
are addressed and osteoporosis is treated. New experimental approaches are being
investigated to manage osteoporosis through surgical approaches in people with
extremely high risk of recurrent hip fractures.
Keywords: Alzheimer’s disease, Cognitive impairment, Dementia, Falls, Hip
fracture, Orthogeriatric, Prevention, Rehabilitation, Risk factors, Treatment.
