Fragility Fractures in Hip and the Distal Radius: Difference in the Age-groups and Its Implications on Preventing Hip Fractures

Fragility Fractures in Hip and the Distal Radius: Difference in the Age-groups and Its Implications on Preventing Hip Fractures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Fragility Fractures in Hip and the Distal Radius: Difference in the Age-groups and Its Implications on Preventing Hip Fractures Sumith Marian Colaco, Vihar Joshi, Himani Kotian, Rakshith N Patil This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6166442/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Fragility fractures are commonly seen in the distal radius and hip in osteoporotic individuals. While hip fractures have high mortality rates, distal radius fractures are known to cause morbidity in the form of wrist stiffness. This study aims to compare the chronological age of patients who sustain distal radius and hip fractures following a trivial injury. Methods: The study was done by reviewing available in-patient medical records between January 2019 and July 2024 of patients aged 50 years or older with distal radius and hip fractures following a trivial trauma. The chronological age of all patients satisfying our inclusion criteria were noted. This data was analysed on Jamovi software version 2.6.17 by using a Mann Whitney U test, the age difference of patients sustaining distal radius fractures with that of those sustaining hip fractures were analysed. Results: This study included 362 patients, of which 112 had sustained distal radius fracture and 250 had sustained hip fractures. 61.2 years was the mean age for distal radius fractures, while that of hip fractures was 72.3 years. Age groups of these two fragility fractures showed a difference which was significant with a T statistic value of 5589 and p<0.001. Conclusion: Increased risk of sustaining fragility fracture in the hip as compared to distal radius with increasing age can be attributed to the delayed response to a fall, resulting in a direct impact on the hip on striking the floor. As the mortality associated with hip fractures are high, training to improve the reflexes, particularly those focused on developing the response of an outstretched hand during a fall should be incorporated as a part of the daily activity for the elderly individuals. Distal Radius Fracture Osteoporosis Hip Fracture Mortality Comparison Fragility fracture Figures Figure 1 Figure 2 BACKGROUND Osteoporosis is a disease that significantly affects the public health. It can be defined as a condition of decreased bone mass and deterioration of its microarchitecture leading to bones becoming fragile, making them more susceptible to fractures. 1 The term osteoporosis literally translates to “Porous bone”. This bone loss occurs gradually over time because of which the diagnosis is often delayed. The first point of diagnosis usually is when the patients present with a fragility fracture. 2 Fragility fractures are those that occur due to a suboptimal mechanical force which otherwise would not cause fracture in a normal bone. These fractures occur following a trivial trauma, like fall from standing height. Distal end of the radius and hip are the sites where they commonly occur. Hip fractures are known to cause significant decrease in the probability of survival with studies showing upto a five time increase in the mortality as compared to the general population 3 . Distal radius fractures are known to cause morbidity in the form of poor wrist function, but there is no increase in the mortality risk 4 .Thus, the longevity of patients with distal radius fracture is far better than those with hip fractures. Moreover, few studies have shown that individuals previously sustaining a fragility fracture in the distal radius are at a higher risk to subsequently sustain a fracture in the hip 5,6,7 . However, we have not come across any study comparing the age groups of patients with these fragility fractures. Our aim was to compare the age group of patients who had fragility fractures in the distal radius to those sustaining it in the hip, and to look for any significant difference. METHODS We did this study in a tertiary healthcare setting in Southern India. Approval from the Institutional Ethics Committee was taken prior to starting the study. The available in-patient medical records between January 2019 and July 2024 of patients aged 50 years or more with hip fractures and those with distal radius fractures following a trivial trauma were reviewed. We excluded patients with history suggestive of high-energy trauma, multiple fractures, previous fractures in the same site, diagnosed cases of osteoporosis on treatment, estrogen replacement therapy, cerebrovascular accidents, Alzheimer’s disease, Parkinsonism and other neurodegenerative disorders. The data pertaining to the patients’ age belonging to both groups were collected and entered into Microsoft Excel, which was then transferred to Jamovi software version 2.6.17, for analysis. Descriptive statistics such as mean and standard deviation / median interquartile range were reported for age group of distal radius and hip fractures. Comparison of the age group of patients sustaining distal radius fractures and those sustaining hip fractures was done with Mann Whitney U Test . The difference was considered as significant if p value was less than 0.001. RESULTS We considered 362 patients suitable for the study based on the inclusion and exclusion criteria. Of these, 112 had sustained distal radius fracture and 250 had sustained hip fractures. Among the patients with hip fractures, 56.8% (142) were pertrochanteric fractures and 43.2% (108) were neck of femur fractures. Average age of patients with distal radius fracture was 61.4 years (Range- 50 to 86 years) and that of patients with hip fractures was 72.3 years (Range- 50 to 95 years). Table 1 shows the sex distribution and Table 2 shows the side distribution for distal radius fractures. Age distribution of distal radius fractures is shown in Fig. 1 . Table 1 Sex distribution in Distal Radius Fractures: Gender Number Percentage Male 44 39.3 Female 68 60.7 Total 112 100 Table 2 Side distribution in Distal Radius Fractures: Side Number Percentage Right 45 40.2 Left 67 59.8 Total 112 100 Table 3 shows the sex distribution and Table 4 shows side distribution for patients with hip fractures. Figure 2 shows age distribution in hip fractures. Table 3 Sex distribution in Hip Fractures: Gender Numbers Percentage Male 82 32.8 Female 168 67.2 Total 250 100 Table 4 Side distribution in Hip Fractures: Side Number Percentage Right 127 50.8 Left 123 49.2 Total 250 100 Table 3 Comparison of age groups Groups Number Median Inter-quartile Range T Statistic* p value Distal Radius Fractures 112 59.5 14.0 5589 < 0.001 Hip Fractures 250 73 12.8 *Since the distribution doesn’t follow normal distribution, Mann-Whitney U Test was done to compare the age groups Difference in the age groups of distal radius and hip fractures showed a statistically significant difference with a p < 0.001 and T statistic value of 5589. DISCUSSION The main purpose of our study was to compare and look for any significant difference between the age groups of patients sustaining fragility fractures in the hip and distal radius along with its implications. The proportion of females sustaining fragility fractures both in the hip and distal radius was nearly twice as that of males and was consistent with other similar studies done in the past 8 , 9 . This can be attributed to the higher prevalence of osteoporosis in women after menopause 10 . Existing literature shows that the incidence of distal radius fragility fractures is maximum between 60 to 70 years with no significant difference in the side distribution of these fractures. 9 , 10 Though we had similar findings with respect to side distribution of these fractures, the age distribution was found to be comparatively lower, between 50 to 60 years with mean age group of 61.4 years. Haleem S et al. showed the mean age of hip fractures at presentation has steadily increased over the past 60 years. 11 In India, a study done by Dhanwal DK et al. showed that hip fractures were predominantly seen from 90 to 95 years in women, and 85 to 90 years in men 12 .This was comparatively lower in our study, with the majority of the age distribution lying between 70 and 80 years. In Our study, the mean age of hip fractures was72.3 years. Furthermore, hip fractures are known to be associated with high mortality risk. Barceló M Et. Al showed that the mortality rate in two years following hip fractures was 32.7%. Pneumonia and cardiovascular complications were leading causes of mortality in these patients. They also noted that advanced age was one of the factors with higher relative risk for mortality 13 . Similarly, another study by C Mellner et Al showed 1 year mortality following hip fracture stands at 26 percent 14 . However, as shown by JW Lee Et Al, distal radius fractures are not associated with increase in the mortality risk. 15 . Thus, we felt it crucial to look for any significant differences in the age groups of these two fractures, and to use its implications to make necessary recommendations in order to prevent the incidence of hip fractures. On making this comparison, we found that the age group of patients with fragility fractures in the distal radius was significantly lower as compared to the hip. This could possibly be due to the difference in the mechanism of injury of these two fractures. Distal radius fragility fractures usually occur while an outstretched hand strikes the ground during a fall. On the other hand, fragility fractures in the hip occur following a slip and fall resulting in the hip striking the ground. It is well established that cognitive functions and acquired reflexes decline with age 16 . Thus, hip striking the ground can be attributed to decline of the acquired reflexes in older individuals, particularly that of an outstretched hand in response to a fall. The findings of our study highlight the need to focus on improving these acquired reflexes in the elderly. Exercises focused on improving the balance, practiced for more than 3 hours a week have shown significant reduction in the incidence of falls 17 . Agility based training comprising cognitive exercises have shown to improve balance, decision making and decrease the fear of falling among elderly 18 , 19 . Therefore, we recommend incorporating these exercises in the daily lives of individuals aged more than 50 years. This can play a significant role in decreasing the incidence of fragility fractures in the hip, thereby reducing the mortality risk associated with these fractures in older individuals. Our study had certain limitations. Firstly, It was a retrospective study. A prospective study including a bigger study population would be required to adequately assess the difference in the age groups of these patients. Secondly, the Indian subcontinent has a diverse geographical distribution, genetic composition and varied socioeconomic conditions. The results of our study is limited to data obtained from a single center, catering to a particular section of the population. The data can vary in other places and the results need not be similar. A multi centric study across regions would be better to further introspect this difference in the age groups of these fractures CONCLUSION We conclude that higher risk of sustaining fragility fracture in the hip as compared to distal radius with increasing age can be attributed to the delayed response to a fall, resulting in a direct impact on the hip on striking the floor. As the mortality associated with hip fractures are high, training to improve the response to fall, particularly those focused on developing the response of an outstretched hand during a fall should be incorporated as a part of the daily activity for the elderly individuals. Additionally, agility exercises and activities for improving balance should be made a part of daily activity to minimise the chances of sustaining hip fractures. Declarations Ethics Approval: Ethical approval was received from the Institutional Ethics Committee of Kasturba Medical College, Mangalore (Reg. No. ECR/541/Inst/KA/2014/RR-200, DHR Reg. No. EC/NEW/INST/2022/KA/0183) approval was sought on 19/09/2024 prior to the commencement of our study. The collection of data was done in accordance with the declaration of Helsinki. Consent to participate: Consent to participate in the study was waived off by the Institutional Ethics Committee as this was a retrospective study involving collection of data from past medical records without any active participation, intervention or divulge any personal identifiable information of patients. Consent for publication: Not applicable Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests Funding: Nil Authors' contributions : SM contributed to the study by collecting the required data. VJ contributed to drafting and revising the manuscript. H contributed to the study by conducting the statistical analysis of the data. RNP contributed in designing the study, formulated the protocol for the study collecting the data. All authors read and approved the final manuscript. Acknowledgements: Not applicable Clinical trial number: Not applicable References Harvey N, Dennison E, Cooper C. The epidemiology of osteoporotic fractures. Primer on the metabolic bone diseases and disorders of mineral metabolism. 2013 Jul 19:348-56. Vestergaard P, Rejnmark L, Mosekilde L. Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporosis International. 2005 Feb;16:134-41. George J, Sharma V, Farooque K, Trikha V, Mittal S, Malhotra R. Excess mortality in elderly hip fracture patients: An Indian experience. Chinese Journal of Traumatology. 2023 Nov 1;26(6):363-8. Patel DS, Statuta SM, Ahmed N. Common fractures of the radius and ulna. American Family Physician. 2021 Mar 15;103(6):345-54. Chen CW, Huang TL, Su LT, Kuo YC, Wu SC, Li CY, Chen KB, Sung FC. Incidence of subsequent hip fractures is significantly increased within the first month after distal radius fracture in patients older than 60 years. Journal of Trauma and Acute Care Surgery. 2013 Jan 1;74(1):317-21. Johnson NA, Stirling ER, Divall P, Thompson JR, Ullah AS, Dias JJ. Risk of hip fracture following a wrist fracture—a meta-analysis. Injury. 2017 Feb 1;48(2):399-405. Choi HG, Kim DS, Lee B, Youk H, Lee JW. High risk of hip and spinal fractures after distal radius fracture: A longitudinal follow-up study using a national sample cohort. International Journal of Environmental Research and Public Health. 2021 Jul 10;18(14):7391. Skuladottir SS, Gudmundsdottir E, Mogensen B, Masdottir HR, Gudmundsdottir H, Jonsdottir LA, Sigurthorsdottir I, Torfadottir JE, Thorsteinsdottir T. Hip fractures among older people in Iceland between 2008 and 2012. International journal of orthopaedic and trauma nursing. 2019 Feb 1;32:27-31. Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M. Epidemiology of hip fractures. Bone. 1996 Jan 1;18(1):S57-63. Eghbali T, Abdi K, Nazari M, Mohammadnejad E, Gheshlagh RG. Prevalence of osteoporosis among Iranian postmenopausal women: A systematic review and meta-analysis. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2022 Mar;15:11795441211072471. Haleem S, Choudri MJ, Kainth GS, Parker MJ. Mortality following hip fracture: Trends and geographical variations over the last SIXTY years. Injury. 2023 Feb 1;54(2):620-9. Dhanwal DK, Siwach R, Dixit V, Mithal A, Jameson K, Cooper C. Incidence of hip fracture in Rohtak district, North India. Archives of osteoporosis. 2013 Dec;8:1-5. Barceló M, Torres OH, Mascaró J, Casademont J. Hip fracture and mortality: study of specific causes of death and risk factors. Archives of osteoporosis. 2021 Dec;16:1-8. Mellner C, Hedström M, Hommel A, Sköldenberg O, Eisler T, Mukka S. The Sernbo score as a predictor of 1-year mortality after hip fracture: a registry study on 55,716 patients. European Journal of Trauma and Emergency Surgery. 2021 Dec;47:2043-8. Lee JW, Lee YB, Kwon BC, Yoo JH, Choi HG. Mortality and cause of death in distal radius fracture patients: A longitudinal follow-up study using a national sample cohort. Medicine. 2019 Dec 1;98(52):e18604. Brito DV, Esteves F, Rajado AT, Silva N, Araújo I, Bragança J, Castelo-Branco P, Nóbrega C. Assessing cognitive decline in the aging brain: Lessons from rodent and human studies. npj Aging. 2023 Oct 19;9(1):23. Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, Cumming RG, Herbert RD, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British journal of sports medicine. 2017 Dec 1;51(24):1750-8. Donath L, van Dieën J, Faude O. Exercise-based fall prevention in the elderly: what about agility?. Sports medicine. 2016 Feb;46:143-9. Hadjistavropoulos T, Carleton RN, Delbaere K, Barden J, Zwakhalen S, Fitzgerald B, Ghandehari OO, Hadjistavropoulos H. The relationship of fear of falling and balance confidence with balance and dual tasking performance. Psychology and aging. 2012 Mar;27(1):1. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6166442","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":433370003,"identity":"d07accdd-f809-4f02-ab6b-59bf1740d140","order_by":0,"name":"Sumith Marian Colaco","email":"","orcid":"","institution":"Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India","correspondingAuthor":false,"prefix":"","firstName":"Sumith","middleName":"Marian","lastName":"Colaco","suffix":""},{"id":433370004,"identity":"b36edb15-8fab-4adb-957a-7ab3cdd4cab8","order_by":1,"name":"Vihar Joshi","email":"","orcid":"","institution":"Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India","correspondingAuthor":false,"prefix":"","firstName":"Vihar","middleName":"","lastName":"Joshi","suffix":""},{"id":433370005,"identity":"d74ec1f6-78b2-4b29-8db2-34863538f05a","order_by":2,"name":"Himani Kotian","email":"","orcid":"","institution":"Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India","correspondingAuthor":false,"prefix":"","firstName":"Himani","middleName":"","lastName":"Kotian","suffix":""},{"id":433370006,"identity":"b7dd8819-8cc6-4264-b169-8ddaa4b8d133","order_by":3,"name":"Rakshith N Patil","email":"data:image/png;base64,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","orcid":"","institution":"Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India","correspondingAuthor":true,"prefix":"","firstName":"Rakshith","middleName":"N","lastName":"Patil","suffix":""}],"badges":[],"createdAt":"2025-03-06 02:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6166442/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6166442/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79662111,"identity":"14a3f99c-35aa-420c-9e95-6d8ef856135e","added_by":"auto","created_at":"2025-04-01 09:51:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30872,"visible":true,"origin":"","legend":"\u003cp\u003eAge distribution of Distal Radius Fractures\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6166442/v1/be5d447d93b5bbe64067aa6a.png"},{"id":79662112,"identity":"a1c5a624-c81e-4902-8dcc-65bb1548f9b4","added_by":"auto","created_at":"2025-04-01 09:51:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":34953,"visible":true,"origin":"","legend":"\u003cp\u003eAge distribution of Hip Fractures\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6166442/v1/62dbc6bf30d9bdab98692fa7.png"},{"id":85500396,"identity":"ac273981-3348-41fc-9a8b-c1198321704e","added_by":"auto","created_at":"2025-06-26 14:32:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":533759,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6166442/v1/c5ce685a-54a9-4165-88a7-7b486041d380.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFragility Fractures in Hip and the Distal Radius: Difference in the Age-groups and Its Implications on Preventing Hip Fractures\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eOsteoporosis is a disease that significantly affects the public health. It can be defined as a condition of decreased bone mass and deterioration of its microarchitecture leading to bones becoming fragile, making them more susceptible to fractures.\u003csup\u003e1\u003c/sup\u003e The term osteoporosis literally translates to “Porous bone”. This bone loss occurs gradually over time because of which the diagnosis is often delayed. The first point of diagnosis usually is when the patients present with a fragility fracture.\u003csup\u003e2\u003c/sup\u003e Fragility fractures are those that occur due to a suboptimal mechanical force which otherwise would not cause fracture in a normal bone. These fractures occur following a trivial trauma, like fall from standing height. Distal end of the radius and hip are the sites where they commonly occur. Hip fractures are known to cause significant decrease in the probability of survival with studies showing upto a five time increase in the mortality as compared to the general population\u003csup\u003e3\u003c/sup\u003e. Distal radius fractures are known to cause morbidity in the form of poor wrist function, but there is no increase in the mortality risk\u003csup\u003e4\u003c/sup\u003e.Thus, the longevity of patients with distal radius fracture is far better than those with hip fractures. Moreover, few studies have shown that individuals previously sustaining a fragility fracture in the distal radius are at a higher risk to subsequently sustain a fracture in the hip\u003csup\u003e5,6,7\u003c/sup\u003e. However, we have not come across any study comparing the age groups of patients with these fragility fractures. Our aim was to compare the age group of patients who had fragility fractures in the distal radius to those sustaining it in the hip, and to look for any significant difference.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eWe did this study in a tertiary healthcare setting in Southern India. Approval from the Institutional Ethics Committee was taken prior to starting the study. The available in-patient medical records between January 2019 and July 2024 of patients aged 50 years or more with hip fractures and those with \u0026nbsp;distal radius fractures following a trivial trauma were reviewed. We excluded patients with history suggestive of high-energy trauma, multiple fractures, previous fractures in the same site, diagnosed cases of osteoporosis on treatment, estrogen replacement therapy, cerebrovascular accidents, Alzheimer’s disease, Parkinsonism and other \u0026nbsp;neurodegenerative disorders.\u003c/p\u003e\n\u003cp\u003eThe data pertaining to the patients’ age belonging to both groups were collected and entered into Microsoft Excel, which was then transferred to Jamovi software version 2.6.17, for analysis. Descriptive statistics such as mean and standard deviation / median interquartile range were reported for age group of distal radius and hip fractures. Comparison of \u0026nbsp;the age group of patients sustaining distal radius fractures and those sustaining hip fractures was done with Mann Whitney U Test . The difference was considered as significant if p value was less than 0.001.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eWe considered 362 patients suitable for the study based on the inclusion and exclusion criteria. Of these, 112 had sustained distal radius fracture and 250 had sustained hip fractures. Among the patients with hip fractures, 56.8% (142) were pertrochanteric fractures and 43.2% (108) were neck of femur fractures.\u003c/p\u003e \u003cp\u003eAverage age of patients with distal radius fracture was 61.4 years (Range- 50 to 86 years) and that of patients with hip fractures was 72.3 years (Range- 50 to 95 years).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the sex distribution and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the side distribution for distal radius fractures. Age distribution of distal radius fractures is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSex distribution in Distal Radius Fractures:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSide distribution in Distal Radius Fractures:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the sex distribution and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows side distribution for patients with hip fractures. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows age distribution in hip fractures.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSex distribution in Hip Fractures:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumbers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSide distribution in Hip Fractures:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of age groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInter-quartile Range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT Statistic*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal Radius Fractures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5589\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip Fractures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Since the distribution doesn\u0026rsquo;t follow normal distribution, Mann-Whitney U Test was done to compare the age groups\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eDifference in the age groups of distal radius and hip fractures showed a statistically significant difference with a p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and T statistic value of 5589.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe main purpose of our study was to compare and look for any significant difference between the age groups of patients sustaining fragility fractures in the hip and distal radius along with its implications. The proportion of females sustaining fragility fractures both in the hip and distal radius was nearly twice as that of males and was consistent with other similar studies done in the past\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. This can be attributed to the higher prevalence of osteoporosis in women after menopause\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eExisting literature shows that the incidence of distal radius fragility fractures is maximum between 60 to 70 years with no significant difference in the side distribution of these fractures.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Though we had similar findings with respect to side distribution of these fractures, the age distribution was found to be comparatively lower, between 50 to 60 years with mean age group of 61.4 years.\u003c/p\u003e \u003cp\u003eHaleem S et al. showed the mean age of hip fractures at presentation has steadily increased over the past 60 years.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e In India, a study done by Dhanwal DK et al. showed that hip fractures were predominantly seen from 90 to 95 years in women, and 85 to 90 years in men\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.This was comparatively lower in our study, with the majority of the age distribution lying between 70 and 80 years. In Our study, the mean age of hip fractures was72.3 years.\u003c/p\u003e \u003cp\u003eFurthermore, hip fractures are known to be associated with high mortality risk. Barcel\u0026oacute; M Et. Al showed that the mortality rate in two years following hip fractures was 32.7%. Pneumonia and cardiovascular complications were leading causes of mortality in these patients. They also noted that advanced age was one of the factors with higher relative risk for mortality\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Similarly, another study by C Mellner et Al showed 1 year mortality following hip fracture stands at 26 percent\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. However, as shown by JW Lee Et Al, distal radius fractures are not associated with increase in the mortality risk.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Thus, we felt it crucial to look for any significant differences in the age groups of these two fractures, and to use its implications to make necessary recommendations in order to prevent the incidence of hip fractures.\u003c/p\u003e \u003cp\u003eOn making this comparison, we found that the age group of patients with fragility fractures in the distal radius was significantly lower as compared to the hip. This could possibly be due to the difference in the mechanism of injury of these two fractures. Distal radius fragility fractures usually occur while an outstretched hand strikes the ground during a fall. On the other hand, fragility fractures in the hip occur following a slip and fall resulting in the hip striking the ground. It is well established that cognitive functions and acquired reflexes decline with age\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Thus, hip striking the ground can be attributed to decline of the acquired reflexes in older individuals, particularly that of an outstretched hand in response to a fall. The findings of our study highlight the need to focus on improving these acquired reflexes in the elderly. Exercises focused on improving the balance, practiced for more than 3 hours a week have shown significant reduction in the incidence of falls\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Agility based training comprising cognitive exercises have shown to improve balance, decision making and decrease the fear of falling among elderly\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Therefore, we recommend incorporating these exercises in the daily lives of individuals aged more than 50 years. This can play a significant role in decreasing the incidence of fragility fractures in the hip, thereby reducing the mortality risk associated with these fractures in older individuals.\u003c/p\u003e \u003cp\u003eOur study had certain limitations. Firstly, It was a retrospective study. A prospective study including a bigger study population would be required to adequately assess the difference in the age groups of these patients. Secondly, the Indian subcontinent has a diverse geographical distribution, genetic composition and varied socioeconomic conditions. The results of our study is limited to data obtained from a single center, catering to a particular section of the population. The data can vary in other places and the results need not be similar. A multi centric study across regions would be better to further introspect this difference in the age groups of these fractures\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eWe conclude that higher risk of sustaining fragility fracture in the hip as compared to distal radius with increasing age can be attributed to the delayed response to a fall, resulting in a direct impact on the hip on striking the floor. As the mortality associated with hip fractures are high, training to improve the response to fall, particularly those focused on developing the response of an outstretched hand during a fall should be incorporated as a part of the daily activity for the elderly individuals. \u0026nbsp;Additionally, agility exercises and activities for improving balance should be made a part of daily activity to minimise the chances of sustaining hip fractures.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval:\u0026nbsp;\u003c/strong\u003eEthical approval was received from the Institutional Ethics Committee of Kasturba Medical College, Mangalore (Reg. No. ECR/541/Inst/KA/2014/RR-200, DHR Reg. No. EC/NEW/INST/2022/KA/0183) approval was sought on 19/09/2024 prior to the commencement of our study.\u003c/p\u003e\n\u003cp\u003eThe collection of data was done in accordance with the declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eConsent to participate in the study was waived off by the Institutional Ethics Committee as this was a retrospective study involving collection of data from past medical records without any active participation, intervention or divulge any personal identifiable information of patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Nil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e: SM contributed to the study by collecting the required data. VJ contributed to drafting and revising the manuscript. H contributed to the study by conducting the statistical analysis of the data. RNP contributed in designing the study, formulated the protocol for the study collecting the data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHarvey N, Dennison E, Cooper C. The epidemiology of osteoporotic fractures. Primer on the metabolic bone diseases and disorders of mineral metabolism. 2013 Jul 19:348-56.\u003c/li\u003e\n \u003cli\u003eVestergaard P, Rejnmark L, Mosekilde L. Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporosis International. 2005 Feb;16:134-41.\u003c/li\u003e\n \u003cli\u003eGeorge J, Sharma V, Farooque K, Trikha V, Mittal S, Malhotra R. Excess mortality in elderly hip fracture patients: An Indian experience. Chinese Journal of Traumatology. 2023 Nov 1;26(6):363-8.\u003c/li\u003e\n \u003cli\u003ePatel DS, Statuta SM, Ahmed N. Common fractures of the radius and ulna. American Family Physician. 2021 Mar 15;103(6):345-54.\u003c/li\u003e\n \u003cli\u003eChen CW, Huang TL, Su LT, Kuo YC, Wu SC, Li CY, Chen KB, Sung FC. Incidence of subsequent hip fractures is significantly increased within the first month after distal radius fracture in patients older than 60 years. Journal of Trauma and Acute Care Surgery. 2013 Jan 1;74(1):317-21.\u003c/li\u003e\n \u003cli\u003eJohnson NA, Stirling ER, Divall P, Thompson JR, Ullah AS, Dias JJ. Risk of hip fracture following a wrist fracture\u0026mdash;a meta-analysis. Injury. 2017 Feb 1;48(2):399-405.\u003c/li\u003e\n \u003cli\u003eChoi HG, Kim DS, Lee B, Youk H, Lee JW. High risk of hip and spinal fractures after distal radius fracture: A longitudinal follow-up study using a national sample cohort. International Journal of Environmental Research and Public Health. 2021 Jul 10;18(14):7391.\u003c/li\u003e\n \u003cli\u003eSkuladottir SS, Gudmundsdottir E, Mogensen B, Masdottir HR, Gudmundsdottir H, Jonsdottir LA, Sigurthorsdottir I, Torfadottir JE, Thorsteinsdottir T. Hip fractures among older people in Iceland between 2008 and 2012. International journal of orthopaedic and trauma nursing. 2019 Feb 1;32:27-31.\u003c/li\u003e\n \u003cli\u003eKannus P, Parkkari J, Siev\u0026auml;nen H, Heinonen A, Vuori I, J\u0026auml;rvinen M. Epidemiology of hip fractures. Bone. 1996 Jan 1;18(1):S57-63.\u003c/li\u003e\n \u003cli\u003eEghbali T, Abdi K, Nazari M, Mohammadnejad E, Gheshlagh RG. Prevalence of osteoporosis among Iranian postmenopausal women: A systematic review and meta-analysis. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2022 Mar;15:11795441211072471.\u003c/li\u003e\n \u003cli\u003eHaleem S, Choudri MJ, Kainth GS, Parker MJ. Mortality following hip fracture: Trends and geographical variations over the last SIXTY years. Injury. 2023 Feb 1;54(2):620-9.\u003c/li\u003e\n \u003cli\u003eDhanwal DK, Siwach R, Dixit V, Mithal A, Jameson K, Cooper C. Incidence of hip fracture in Rohtak district, North India. Archives of osteoporosis. 2013 Dec;8:1-5.\u003c/li\u003e\n \u003cli\u003eBarcel\u0026oacute; M, Torres OH, Mascar\u0026oacute; J, Casademont J. Hip fracture and mortality: study of specific causes of death and risk factors. Archives of osteoporosis. 2021 Dec;16:1-8.\u003c/li\u003e\n \u003cli\u003eMellner C, Hedstr\u0026ouml;m M, Hommel A, Sk\u0026ouml;ldenberg O, Eisler T, Mukka S. The Sernbo score as a predictor of 1-year mortality after hip fracture: a registry study on 55,716 patients. European Journal of Trauma and Emergency Surgery. 2021 Dec;47:2043-8.\u003c/li\u003e\n \u003cli\u003eLee JW, Lee YB, Kwon BC, Yoo JH, Choi HG. Mortality and cause of death in distal radius fracture patients: A longitudinal follow-up study using a national sample cohort. Medicine. 2019 Dec 1;98(52):e18604.\u003c/li\u003e\n \u003cli\u003eBrito DV, Esteves F, Rajado AT, Silva N, Ara\u0026uacute;jo I, Bragan\u0026ccedil;a J, Castelo-Branco P, N\u0026oacute;brega C. Assessing cognitive decline in the aging brain: Lessons from rodent and human studies. npj Aging. 2023 Oct 19;9(1):23.\u003c/li\u003e\n \u003cli\u003eSherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, Cumming RG, Herbert RD, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British journal of sports medicine. 2017 Dec 1;51(24):1750-8.\u003c/li\u003e\n \u003cli\u003eDonath L, van Die\u0026euml;n J, Faude O. Exercise-based fall prevention in the elderly: what about agility?. Sports medicine. 2016 Feb;46:143-9.\u003c/li\u003e\n \u003cli\u003eHadjistavropoulos T, Carleton RN, Delbaere K, Barden J, Zwakhalen S, Fitzgerald B, Ghandehari OO, Hadjistavropoulos H. The relationship of fear of falling and balance confidence with balance and dual tasking performance. Psychology and aging. 2012 Mar;27(1):1.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Distal Radius Fracture, Osteoporosis, Hip Fracture, Mortality, Comparison, Fragility fracture","lastPublishedDoi":"10.21203/rs.3.rs-6166442/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6166442/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eFragility fractures are commonly seen in the distal radius and hip in osteoporotic individuals. While hip fractures have high mortality rates, distal radius fractures are known to cause morbidity in the form of wrist stiffness. This study aims to compare the chronological age of patients who sustain distal radius and hip fractures following a trivial injury.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The study was done by reviewing available in-patient medical records between January 2019 and July 2024 of patients aged 50 years or older with distal radius and hip fractures following a trivial trauma. The chronological age of all patients satisfying our inclusion criteria were noted. This data was analysed on Jamovi software version 2.6.17 by using a Mann Whitney U test, the age difference of patients sustaining distal radius fractures with that of those sustaining hip fractures were analysed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e This study included 362 patients, of which 112 had sustained distal radius fracture and 250 had sustained hip fractures. 61.2 years was the mean age for distal radius fractures, while that of hip fractures was 72.3 years. Age groups of these two fragility fractures showed a difference which was significant with a T statistic value of 5589 and p\u0026lt;0.001.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Increased risk of sustaining fragility fracture in the hip as compared to distal radius with increasing age can be attributed to the delayed response to a fall, resulting in a direct impact on the hip on striking the floor. As the mortality associated with hip fractures are high, training to improve the reflexes, particularly those focused on developing the response of an outstretched hand during a fall should be incorporated as a part of the daily activity for the elderly individuals.\u003c/p\u003e","manuscriptTitle":"Fragility Fractures in Hip and the Distal Radius: Difference in the Age-groups and Its Implications on Preventing Hip Fractures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-01 09:50:56","doi":"10.21203/rs.3.rs-6166442/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"10b22da5-e2a9-4eb4-a537-d07aca82031a","owner":[],"postedDate":"April 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-26T14:24:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-01 09:50:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6166442","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6166442","identity":"rs-6166442","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}