ABSTRACT
The National Institute for Health and Care Excellence (NICE) updated its Clinical Guideline and its Quality Standard on hip fracture in 2017. Three quality statements relate to the organisation of care-having a multidisciplinary hip fracture programme, and both operating and starting rehabilitation without delay-while three relate to surgical aspects, the most recent being the requirement to offer total hip replacement rather than hemiarthroplasty for those with displaced intracapsular fractures who could mobilise outdoors with a stick. Some evidence exists to support this, but the timely provision of this more complex and specialised operation presents a logistical challenge to many units. The evidence for many more general aspects of the care of hip fracture patients is still extrapolated from other populations, and more research is needed to guide the care of this specific group.
Subject(s)
Arthroplasty, Replacement, Hip/standards , Evidence-Based Medicine/standards , Femoral Neck Fractures/surgery , Hemiarthroplasty/standards , Hip Joint/surgery , Practice Guidelines as Topic/standards , Age Factors , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/instrumentation , Arthroplasty, Replacement, Hip/rehabilitation , Biomechanical Phenomena , Clinical Decision-Making , Femoral Neck Fractures/diagnostic imaging , Femoral Neck Fractures/physiopathology , Hemiarthroplasty/adverse effects , Hemiarthroplasty/instrumentation , Hemiarthroplasty/rehabilitation , Hip Joint/diagnostic imaging , Hip Joint/physiopathology , Humans , Patient Selection , Recovery of Function , Risk Factors , Time-to-Treatment/standards , Treatment Outcome , Waiting ListsABSTRACT
Alendronate is used as first-line treatment for osteoporosis in postmenopausal women worldwide. The evidence supporting its benefit in reducing the risk of fragility fracture among this high-risk group is well established. Due to its mechanism of action, there were concerns about potential reduction in bone turnover, repair of microdamage and hence reduced bone toughness and increased risk of fractures with long-term use. A number of cases have been reported from other countries describing a pattern of atraumatic mid-femoral fractures in women on long-term alendronate therapy. We present a case of an atraumatic femoral shaft fracture in an elderly woman on long-term alendronate therapy admitted to a UK Hospital.
