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Abstract
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Background: Some observations indicate a difference in nutritional factors between elderly patients suffering different type of fractures in the proximal femur. To elucidate this we performed over a two months period a cross sectional study of 39 elderly patients admitted to Aker university Hospital due to a fracture in the hip.
Methods: Patients admitted to Aker University hospital HF, during a 2 months time period, with a proximal femur fracture needing surgery were included in the project. At time of fracture, the patients were weighed using a class 3 chair scale. Length was measured with a tape measure at bed rest. At the follow up, 3 months later, this was confirmed by standing measurement. Body Mass Index (BMI) was calculated. Activity of daily living, ADL, was recorded by the investigator 3 days postoperatively. A trained nutritionist carried out a Mini Nutrition Assessment at 3 months check up, the ADL was reassessed and Harries hip score recorded. Body composition: Bone Mineral Density (BMD) Bone Mineral Content (BMC), Lean Body Mass (LBM) and Fat Content (FC) was measured using dual X-Ray Absorptiometry (DEXA). Nine healthy patients, aged and sex matched, without a fracture history were examined as a control group.
Results: Thirty-nine patients were included in the study. Both groups tended to be free living in their homes, 83% and 100%, respectively. Fifty nine percent of the patients broke their hip at home. The persons in the control group were healthier then the patient group. The control group scored better on Harries Hip score. No difference could be observed in ADL between the two groups. Comparing ADL at admission to hospital with ADL at 3 months check up, showed a declining trend.
The mean BMI of the control group was higher than for the patient group. Although not significant at this stage in the project, the trend was also for the control group to score higher in mean BMD. The larger difference between BMD and BMC values between the groups indicated the BMC value to be more representative for Bone quality.1 The controls scored better in both Lean Body Mass (LBM) and Fat-content (FC).
The patients with trochanteric fractures showed better nutritional values than the patients with medial neck fractures. The "neck" group scored on average low in the Mini Nutrition Assessment, indicating the patients being mal nourished. The trochanteric group scored lower then the control group indicating this group being at risk for malnutrition.
BMI in the trochanteric group of patients was higher than for the "neck" group. There was no difference in BMD, BMC, LBM or FC between these two groups.
Discussion: This study seems to confirm the assumption that malnutrition is a significant factor in proximal femoral fractures in the elderly and that there is a difference between patients with different fracture types in body composition. |