Optimización perioperatoria del paciente anciano con fractura osteoporótica de cadera / Perioperative care of older patients with hip fractures

The number of osteoporotic fractures is increasing along with population aging. Most patients with these type of fractures are older than 65 years, with multiple chronic conditions and different degrees of disability. Hip fracture is the most relevant osteoporotic fracture due to its frequency, costs, severity and complications. Multidisciplinary management is of the utmost importance to obtain good therapeutic results. We herein review the management of this fracture. Orthogeriatric joint management should be incorporated in fragility fracture treatment. We contribute with general recommendations for the perioperative management, which can be homologated for the management of older patients with other type of fragility fractures.

Prevalencia de insuficiencia y deficiencia de vitamina D en adultos mayores con fractura de cadera en Chile / Vitamin D levels among Chilean older subjects with low energy hip fracture

Background: Vitamin D deficiency is a common condition affecting 40-100% of geriatric population. Aim: To determine the prevalence of vitamin D insufficiency and deficiency in geriatric population surgically treated for hip fracture. Patients and Methods: Analysis of a database of patients aged over 60 years operated for a low energy hip fracture in a three years period. Vitamin D was measured in identified patients, using a blood sample obtained on admission to the hospital. A logistic regression was carried out to evaluate age, gender, morbidity index and season as predictors of vitamin D deficiency. Results: Two hundred and twenty-eight patients aged 84 ± 7 years (82% females), were included in the analysis. One hundred eighty-three patients (80%) presented vitamin D levels below 20 ng/dl (deficiency) and 39 patients (18%) presented with levels between 20 and 30 ng/dl (insufficiency), totaling 98% of patients with hypovitaminosis D. Vitamin D deficiency was especially common among patients with higher American Society of Anesthesiologists (ASA) Physical Status Classification System and during winter-spring period. A negative correlation between age and the proportion of subjects with vitamin D deficiency was found. There was no relation between gender and vitamin D levels. Conclusions: Vitamin D deficiency is especially prevalent in older subjects with hip fracture, reaching 98% in the studied population.