Men at higher risk of cognitive impairment after hip fracture

After a hip fracture, men are more cognitively impaired - and therefore, more at risk of death - than women, researchers in Baltimore say. By 2025, the number of hip fractures in men will be as high as what's currently seen in women, the researchers warn.

That makes these fractures "an emerging public health concern for older men, their families, and the healthcare system,” according to Dr. Ann Gruber-Baldini of the University of Maryland School of Medicine and her colleagues. “Compared to women, men who fracture a hip have an increased risk of mortality . . . despite their younger age at the time of fracture.”

As reported in the Journal of the American Geriatrics Society, the researchers compared the impact of a hip fracture on thinking skills and risk of death in 166 men and 168 women over age 80.The men had significantly more other diseases to start with, and more of them had been diagnosed with dementia. Men also were significantly more impaired on most cognitive measures.

After taking any pre-fracture dementia and other risk factors into account, men were still at significantly higher risk for poor scores on a variety of tests of thinking skills.Men also had higher mortality rates than women six months after hip fracture - and the men's scores on cognitive tests were significantly associated with their risk of death: those who did poorly on the tests were more likely to die during the study.

On one common test - the modified Mini-Mental-State Exam - nearly a third of the men with poor scores died within six months, compared with 15 percent of women with poor scores and 11 percent of men with no cognitive problems. By contrast, only 2 percent of women without cognitive problems on this test died within six months.No significant interaction effects were seen between gender and cognition.

Gruber-Baldini told Reuters Health, “It may be valuable for clinicians to monitor hip fracture patients after hospital discharge - especially men - to see if they are still experiencing cognitive impairment and effects of delirium.”“Interventions to reduce delirium - evaluation of medications, nutrition, infections, and comorbidities - may be needed,” she said by email. “It is also important that those with cognitive impairment get rehabilitation to help improve their mobility.”

Orthopedic surgeon Dr. John Tiberi of the Kerlan-Jobe Orthopaedic Clinic in Los Angeles, California told Reuters Health, “Hip fractures in the elderly are known to have significant risks, even after appropriate treatment.”

“This study highlights the increasing incidence of hip fractures in men as well as the higher rates of some adverse outcomes in men compared to women,” he said by email. “Knowledge of these findings may better assist health care providers and family members in providing care and support for hip fracture patients during the incredibly important recovery and rehabilitation process.”