Slim patients die more frequently following hip fractures

In elderly patients, a higher body weight can have definite advantages. A Swedish study presented at the EFORT Congress in Istanbul found that elderly people with a higher body weight have a lower risk of dying and of developing pressure ulcers following a hip fracture.

Istanbul, 5 June 2013  – Obesity is a risk factor for a number of diseases. However, in old age,  having  too  little  body  weight  can  also  become  a   major  problem.  Following  hip fractures,  elderly  people  with  a  higher  body  mass  index  have  a  lower  mortality  risk according  to  a   new  Swedish  study  presented  at   the  14th   Congress  of  the  European Federation of National Associations of Orthopaedics and Traumatology (EFORT) in Istanbul. About  7,500  experts  are  discussing  current  developments  in  their  field  at  this  congress. Lead   author   in   the   study   Dr   Lena   Flodin   (Karolinska   Institut,   Stockholm,   Sweden) explained:   “Swedish   patients   with   a   hip   fracture   are   83   years   old   on   average.   The complication rate and mortality are extremely high following these injuries, indicating how frail the patients are.”

For the study, she observed 843 patients over 65 with a hip fracture for the course of one year following the fracture. The body mass index (BMI) was correlated in this group with the probability of a clinical event. Dr Flodin: “The primary goal of the study was to evaluate the influence of the body mass index as a predictor of mortality within one year in a relatively healthy group. The patients had lived in their own households prior to their hip fracture and were not seriously impaired cognitively.” The study showed that a low BMI is a definite predictor  of  death  within  one  year.  In  addition,  a  low  BMI  was  also  associated  with  a heightened risk of pressure ulcers and allowed conclusions to be drawn about the ability of the patients to continue living an independent life. Patients with a higher BMI also had significantly better chances of returning to independent living.

Malnutrition increases mortality after hip  fracture

Dr Flodin: “The purpose of the body mass index is to predict the effects that body fat has on morbidity and mortality in adults. The health authorities in Sweden stipulate a BMI of 20 as the lower limit for people aged 65 to 70 and one of 22 as the lower limit for people over 70. Below  this  score  we  assume  underweight  and  possibly  malnourishment.”  An  excessively high  BMI  is  unfavourable,  as  is  an  excessively  low  BMI.  However,  the  BMI  also  has  a number  of  shortcomings.  A  high  value  may  correlate  well  with  adiposity,  but  key  factors such as age, gender and muscle mass are left out of the picture. That is why there is no consensus regarding limits for elderly people.

Dr Flodin: “One assumes that mortality in geriatric patients with a low body mass index is higher than in those with a normal BMI. That is a frequent problem. Earlier studies from Sweden showed that the incidence of malnutrition is between 14 and 41% amongst elderly people  living  alone.  In  one  study,  25%  of  the  patients  with  a  hip  fracture  were  found  to have a problematically low BMI. There are also indications of a postoperative reduction in the BMI and a loss of muscle and bone mass in the first year following a hip fracture. That is only logical,” the expert explained. “After all, abstinence from food prior to surgery and the waiting time mean reduced calorie intake and can cause a reduction particularly in muscle mass in elderly patients. Following these latest results, we will need further studies to understand  more  fully  the  correlation  between  the  BMI  and  nutritional  state  in  elderly people.”

The   European   Federation   of   National   Associations   of   Orthopaedics   and   Traumatology (EFORT) is the umbrella organisation linking Europe´s national orthopaedic societies. EFORT was founded in  1991 in  the Italian Marentino. Today it  has 42 national member societies from 43 member countries and six associate scientific members.

EFORT   is   a   non-profit   organisation.   The   participating   societies   aim   at   promoting   the exchange  of  scientific  knowledge  and  experience  in  the  prevention  and  treatment  of diseases and injuries of the musculoskeletal system. EFORT organises European congresses, seminars, courses, forums and conferences. It also initiates and supports basic and clinical research.

Source:  EFORT  Abstract  2560:  Body  Mass  Index  as  a  predictor  of  one-year  mortality:  a  prospective  study  of elderly patients with hip fracture.

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