OSTEOPOROSIS & HIP FRACTURE
Osteoporosis is defined as a reduction in the amount of bone mass which leads to fractures after minimal trauma. This reduced bone mass in the elderly population results in reduced bone strength and thus greater susceptibility to fractures.
Bone is a hard connective tissue, whose main functions are as follows:
To provide support and protection through the structure of the skeleton.
To act as a natural chemical reservoir for calcium and phosphorous.
There are two major types of bone structure in the skeleton; cortical and cancellous. Cortical bone tissue, which is compact and dense, comprises the shafts of all long bones. Cancellous bone tissue is a porous three-dimensional lattice whose structural network provides the support of the large contact surfaces at the ends of bones. An example of this is the three-dimensional porous structure in the upper femur located at the hip joint.
Bone Material Remodelling
Throughout life, the bones in the skeleton experience a constant turnover process in which bone material is resorbed and replaced by new bone material. In the adult human skeleton, approximately 5-10% of the existing bone material is replaced each year. The turnover of cortical bone is closer to 5% per year, while the turnover of cancellous bone can be as high as 20% per year.
Over the first two decades of life, the skeleton continues to grow as more and more material is deposited on the bones. Thus the bone remodelling (turnover) process produces a net increase in whole-body bone mass. During young adulthood (i.e. 20's and 30's), the bone remodelling process maintains a general equilibrium of bone mass throughout the body. That is, an equal amount of bone is deposited for the amount that is resorbed.
Age-Related Bone Loss
As the aging process continues (i.e. late 30's and older), the total bone resorption tends to be greater than total bone formation. This normal aging process in both females and males results in a general decrease in skeletal mass over time. Any effects of bone loss will be evident predominantly in cancellous bone (e.g. the upper femur, etc.), due to the higher rate of bone turnover.
In addition, there is an accelerated phase of bone loss, which occurs predominantly in post-menopausal females. Therefore, the cumulative loss of bone mass is greater in elderly females compared to elderly males. The result of this is that elderly females are at greater risk of bone cancellous fractures.
Other factors which contribute to bone loss:
Low body mass
Low levels of physical activity
Low calcium intake
Certain hormone levels
During a slip and fall or any other incident in which an elderly person breaks their hip, the general health of their bones may be relevant to the case. Based on the fragility of their bones, a hip fracture may have been medically predictable for various "everyday" situations (e.g. stepping awkwardly off a curb).
It is difficult to conclude whether a court decision of such a case would hinge on the victim's bone health. However, a medical history review may indicate the susceptibility of minimal-trauma hip fracture, which may prove to be a relevant factor.
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