IL PAZIENTE ANZIANO CON FRATTURA DI FEMORE: VALUTAZIONE E SUPPORTO NUTRIZIONALE

Osteoporosis in the elderly population is a major health problem worldwide, because it is associated with fragility fractures with consequent financial burden for health systems. Europe and North America are the regions where half of all hip fractures among elderly people occurred today, with Scandinavian countries reporting the highest incidence worldwide. Undernutrition, particularly protein malnutrition, is frequent in elderly with osteoporotic hip fracture, although, the role of dietary protein intake in osteoporosis remains controversial. Poor nutritional status is associated with higher comorbidity indices, mortality and readmissions in patients with femoral fracture. Another crucial issue to consider in these patients is that cognitive and functional status significantly affects the nutritional condition. Likewise, anemia, the most common hematological disorder in the elderly and a possible consequence of malnutrition, increases the risk of mortality and morbidity and affects quality of life. The assessment of activities of daily living (ADL) and fall risk is particularly important in these patients, considering that approximately 95% of hip fractures results from falls and that the chances of total recovery of ADL after a hip fracture are low. Cognitive impairment and low physical activity are significant contributing factors for the progression of frailty phenotype to disability. Pre-fracture and incident cognitive impairment during hospitalization are risk factors for poor functional outcomes. There is still limited and not definite evidence for a universal benefit of nutritional supplementation after hip fracture, which may be explained, at least in part, by the heterogeneity of outcomes and design of the available studies. Adequately sized randomized controlled trials are still warranted.