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Hip Fractures: Clue to Alzheimer’s Disease?

In a study of older people with no clinical diagnosis or signs of dementia when hospitalized to repair hip fractures, Johns Hopkins researchers found biomarkers of Alzheimer’s disease in most of the patients’ spinal fluid samples. The study adds to evidence that brain alterations that lead to poor balance in older people may underpin both increased risk of hip-fracturing falls and Alzheimer’s disease—and that hip fracture itself may therefore serve as a first sign of undiagnosed disease.

“We studied a group of patients without a clinical diagnosis of dementia, meaning that many of our study participants were active and living independently without overt signs of Alzheimer’s disease,” says Esther Oh, associate director of the Johns Hopkins Memory and Alzheimer’s Treatment Center.

The study does not suggest that every older person who has a hip fracture has Alzheimer’s, Oh notes, nor should everyone hospitalized for a hip fracture undergo spinal fluid tests for disease biomarkers at this time. But it does suggest that anyone facing hip repair surgery after a fall be monitored closely for signs of postoperative delirium or other mental or cognitive problems during recovery, as some people may have underlying Alzheimer’s disease, which might make them more vulnerable.

Oh noted that several international studies have shown that up to a quarter of older adults hospitalized for hip fracture surgery are likely to die within the following year, results suggesting that a serious medical condition may have been simmering undiagnosed prior to the falls that sent them to the hospital.

The new study, published recently in PLOS ONE, was in part a response to results of research published late 2018 in JAMA Surgery by Johns Hopkins scientists, which showed that 34 percent of hip fracture patients develop delirium during their hospital stay, a condition characterized by restlessness, delusions, and incoherent thoughts and speech. Because patients with Alzheimer’s disease are more likely to experience these symptoms and because of the higher than normal mortality rate associated with hip fracture compared with other surgeries, Oh and her team designed their study to directly test hip fracture patients for Alzheimer’s disease biomarkers.