Broken Shoulder: No laughing matter

Authors: AAOS

Older women who suffer a proximal humerus fracture (sometimes known as a broken shoulder) have a high risk for also breaking a hip within a year after the shoulder injury. A new study presented at the 75th Annual Meeting of the American Academy of Orthpaedic Surgeons (AAOS), found that after a shoulder fracture a woman's risk of fracturing a hip within the following year was five times greater. The risk decreased after the first year but still remained elevated. Understanding the connection between these injuries is important to preventing hip fractures.

Hip fractures account for more than 350,000 hospital admissions in the United States and more than 60,000 nursing home admissions each year. Women have greater risk because of their higher susceptibility to osteoporosis. Statistics show:

-- about 70 percent of hip fracture patients are women
-- more than 4 percent of hip fracture patients die during their initial hospitalization
-- 24 percent die within a year of the injury
-- about half of women who sustain hip fractures lose the ability to walk independently

Preventing hip fracture poses s a significant quality-of-life issue. "Earlier studies have shown that there is an increased risk of hip fracture after a proximal humerus fracture, but our study found that there is a defined window of time in which the risk is much greater than previously thought. Additionally, other research has shown that interventions within the first three months can reduce the risk of subsequent fractures," said Jeremiah Clinton, MD, co-author of the study and acting clinical instructor at the University of Washington, Department of Orthopaedics. "If we maximize our hip-fracture prevention efforts up front, we may have a much better chance of helping the patient avoid a life-changing and potentially life-ending injury."

The study followed a group of older, Caucasian women for nearly 10 years and found that:

14 percent of those who suffered a proximal humerus fracture later sustained a hip fracture. (It should be noted that because older women are at very high risk for hip fracture, more than 8 percent of the women who did not break a shoulder also suffered a fractured hip.)

The strongest risk factors for hip fracture were age and hip bone mineral density. Other factors included:

-- self-reported health status
-- height at 25 years of age
-- history of recent falls
-- impaired depth perception
-- history of prior fractures

Even when controlling these factors, the researchers still found the increased risk for hip fracture in the first year after a proximal humerus fracture.

The reasons for the connection between humerus fracture and hip fracture are still unclear. "It may be associated medical problems, limited use of the injured shoulder, or there could be something about the treatment for the first fracture such as narcotic pain medications which could have caused the patient to fall and break a hip," Dr. Clinton said. "Now that we are aware of the relationship between these types of fractures, we can take precautions, intervene early and hopefully help to prevent some hip fractures from occurring." The authors stress that this message is the key point to be made from their new findings.

American Academy of Orthopaedic Surgeons (AAOS)
6300 N. River Rd.
Rosemont, IL 60018
United States

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