Femoral Neck Fracture: Causes

Pathogenesis (development of disease)

Femoral neck fracture can result from a variety of injury mechanisms.

Etiology (causes)

Injuries, poisonings, and other consequences of external causes (S00-T98).

  • Fall from standing or sitting height
  • Stumbling e.g. over the carpet
  • Chronic overloading of the bone (in osteoporosis) and varus position (“bent outward”).
  • High-rasan trauma with axial compression of the femur.

Bone-related factors leading to an increased likelihood of fracture

Biographic causes

Behavioral causes

  • Nutrition
    • Malnutrition
    • Micronutrient deficiency (vital substances) – vitamin D, calcium.
  • Consumption of stimulants
    • Alcohol (woman: > 40 g/day; man: > 60 g/day).
    • Tobacco (smoking)
  • Physical activity
    • Lack of physical activity
    • Physical inactivity

Disease-related causes

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Malnutrition, unspecified
  • Estrogen deficiency

Musculoskeletal system and connective tissue (M00-M99).

  • Increased rate of bone remodeling, unspecified.
  • Osteoporosis (bone loss)
  • Pathological fracture (spontaneous fracture) – bone fracture without force on a pathologically changed bone.

Psyche – nervous system (F00-F99; G00-G99).

  • Chronic alcohol dependence

Injuries, poisonings, and other sequelae of external causes (S00-T98).

  • Previous low-energy fracture at age > 50 years.

Factors that increase overall risk of injury

Biographical causes

  • Age – advanced age

Behavioral causes

  • Smoking
  • Spatial conditions such as slippery floors or carpets.

Disease-related causes

Eyes and eye appendages (H00-H59).

  • Visual disturbances, unspecified

Cardiovascular system (I00-I99)

  • Apoplexy (stroke)
  • Cardiovascular disease (heart and vascular disease), unspecified

Musculoskeletal system and connective tissue (M00-M99).

  • Foot problems, unspecified
  • Muscle weakness, unspecified

Psyche – nervous system (F00-F99; G00-G99)

  • Alcohol dependence (alcohol abuse)
  • Walking disorders, unspecified
  • Coordination disorders, unspecified
  • Neurological diseases such as Parkinson’s disease.
  • Transient ischemic attack (TIA) – sudden circulatory disturbance of the brain that leads to neurological disorders that remit within 24 hours

Injuries, poisonings and other consequences of external causes (S00-T98).

  • Rasance trauma

Further

  • Long immobility
  • Slow gait pattern
  • Low body weight (BMI < 18.5)

Medication

  • Antidepressants – hip fracture risk in seniors was particularly elevated at baseline and continued for up to 4 years
  • Antihypertensives (antihypertensive medications) – Secondary analysis of ALLHAT trial data confirmed that in hypertensives, therapy with a thiazide diuretic was associated with a reduced risk of hip and pelvic fractures compared with ACE inhibitors or beta-blockers.
  • Hypnotics/sedatives (sedatives/sleep aids).
  • Diuretics (diuretic medications).