![]() 15 It may be that the composition and structure of the hip itself is the determining factor. 14 There is nothing to suggest that certain fall characteristics influence the type of hip fracture that occurs, although this may be the case for upper limb fractures. 13 Currently, there is no evidence to suggest that men and women fall differently with age, although it is known that women fall more frequently. The pattern of falling changes with age, with falling in old age being more commonly from a static position to the side and back and onto the greater trochanter. Additionally, not all falls are the same. Practically, all hip fractures occur in a fall and thus are to some extent traumatic. 11, 12 The cause of hip fractures is complicated. 9, 10 Although osteoporosis will undoubtedly contribute significantly to the risk of a fracture in a fall, most subjects with a hip fracture have a bone mineral density in the normal or osteopenic range. 3 – 8 The structure of the femoral neck may also be important and may influence the type of hip fracture that occurs, with a longer femoral neck and wider neck/shaft angle, favoring a subcapital fracture. Patients with intertrochanteric fractures also tend to be older, have more severe bone loss, and have more other fractures, although not all studies agree. The more common fracture type is the subcapital fracture, which may be less associated with osteoporosis than the intertrochanteric fracture. It is possible that the two fracture types may have different etiologies. 2, 3 In this report, we have extended the observation to a Canadian population over a five-year period and compared community-dwelling residents with residents in long-term care homes. 1 This was found in a study of 2,150 hip fracture patients in London, Ontario (population approximately 350,000), over a five-year period, which was consistent with the findings of others. We previously reported that in women the proportion of intertrochanteric fractures rises with age, while in men it is the proportion of subcapital fractures that rises.
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