Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2016; 7(4): 218-228
Published online Apr 18, 2016. doi: 10.5312/wjo.v7.i4.218
Understanding the pathogenesis of hip fracture in the elderly, osteoporotic theory is not reflected in the outcome of prevention programmes
Enrique Guerado, Rosa M Sandalio, Zaira Caracuel, Enrique Caso
Enrique Guerado, Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, 29603 Malaga, Marbella, Spain
Rosa M Sandalio, Zaira Caracuel, Enrique Caso, Research Unit, Hospital Costa del Sol, University of Malaga, 29603 Malaga, Marbella, Spain
Author contributions: Guerado E directed the paper, and wrote “The Medical Problem” and “The Social Problem”; Sandalio RM wrote “Genomics”; Caracuel Z wrote “Metabolomics”; Caso E wrote “Transcriptome”; the all authors were involved in editing the manuscript.
Conflict-of-interest statement: The authors declare not conflict of interest. No potential bias in a study’s design, interpretation of it results or presentation of its scientific/medical content, including but not limited to commercial, personal, political, intellectual, or religious interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Enrique Guerado, Professor, Chairman, Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Autovia A-7. Km 187, 29603 Malaga, Marbella, Spain. eguerado@hcs.es
Telephone: +34-95-1976224
Received: October 28, 2015
Peer-review started: November 3, 2015
First decision: November 30, 2015
Revised: December 19, 2015
Accepted: December 29, 2015
Article in press: January 4, 2016
Published online: April 18, 2016

Hip fractures are an acute and worsening public health problem. They mainly affect elderly people, a population group that is highly vulnerable to disease and accidents, and to falls in particular. Although it has been suggested that osteoporosis is the cause of hip fractures, they mainly occur after a fall has been suffered. The underlying causes of a fall are not related to osteoporosis, although pharmaceutical companies have coined the term “osteoporotic fracture” for hip fractures in the elderly. Drug treatments for osteoporosis have not diminished the frequency of these injuries, nor have they prevented the occurrence of a subsequent fracture. Since pharmaceutical interests require osteoporosis to be considered a disease, rather than a normal condition of senescence, they go further by assuming that treatment for osteoporosis is essential, and that this policy will diminish the incidence of hip fractures. On the other hand, the origin and treatment of conditions that may be conducive to provoking falls are very difficult to elucidate. In this paper, we consider some of the medical and social problems that arise in this area, as well as conflicts of interest regarding the aetiopathogenesis and prevention of hip fracture, and propose a new paradigm for the prevention of falls.

Keywords: Hip fracture, Osteoporosis, Overtreatment, Social medicine, Political economy, Political actions, Conflict of interest, Genome, Transcriptome, Metabolome

Core tip: This paper rejects the role of osteoporosis in the pathogenesis of hip fracture and proposes medically-based political action to support new omics technologies to detect the risk of falls by elderly people, by detracting resources from those currently employed in the treatment of osteoporosis.