Frailty, osteoporosis and hip fracture: causes, consequences and therapeutic perspectives

Elderly, frail patients are at considerable risk of hip fracture. Yet, they receive little advice about measures that can be taken in order to avoid falling, and little screening or treatment for osteoporosis. This review of the literature focuses on the links between the frailty syndrome and the risk of hip fracture. It has been discussed at a meeting involving geriatricians, endocrinologists, rhuma-tologists and gynaecologists. The concept of frailty enables us to consider a different approach to the elderly person's risk of hip fracture. It would seem advisable to consider preventive measures and specific treatment for the elderly, frail population. The usual approach, involving the treatment of each pathology as an individual case, does not seem appropriate for managing the frail individual. The approach that bases osteoporosis treatment on increasing bone mineral density is not only necessary but also probably inadequate here - the treatment objective must not only be to increase bone mineral density. Preventing falls by improving the determining factors of frailty (strength, nutritional status, physical activity and cognition) should result in fewer fractures. Supplementary studies of frail subjects would improve our understanding of how managing frailty might impact on fracrture rates. At the same time, proper management of osteoporosis should reduce the risk of strong, elderly patients becoming frail and frail subjects becoming dependent.