Musculoskeletal rehabilitation after hip fracture: a review

This review article on musculoskeletal rehabilitation after hip fractures summarizes current scientific evidence concerning prevention, treatment and post-fracture surveillance of patients who sustained a low-trauma hip fracture due to osteoporosis.

With increasing longevity, hip fractures become more and more a serious burden not only for societies in developed civilization, but also for emerging countries. According to world-wide projections 1.5 million people are affected each year. Although a lot of research has been performed over the last decade, there is still a lack of standardized and evidence-based approaches for prevention, treatment and rehabilitation of this worst complication of osteoporosis. Therefore, the evidence base for this article was synthesized in accordance with SIGN methodology. Databases searched include Medline, Embase, CINAHL and the Cochrane Library between January 1996 and March 2010. The following terms are used: osteoporosis, hip fracture, rehabilitation, falls, muscle strength, nutrition, exercise, balance, sway, and hip protectors. Moreover, reference lists from included studies were checked and author’s names were searched for additional studies. Possibly, the best approach to rehabilitation after hip fracture is a multi-disciplinary team co-ordinating medical, social, educational and vocational measure for training or retraining the individual to the highest possible level of function. In order to prevent thromboembolism fondaparinux should be used for 28 days starting 6 h after surgery. This should be accompanied by a daily nutritional intake of at least 20-g protein, 1,200 mg of elemental calcium and 800 IU of vitamin D; whereas in severe vitamin D insufficiencies, recommendations may be certainly higher. After surgical repair of the hip fracture, an anti-resorptive medication should be started. While balance training and performing of Tai Chi has been shown to reduce fall risk and thereby also decrease hip fracture risk, the use of hip protectors is still under evaluation and cannot be generally advocated.