Are the etiologies of cervical and trochanteric hip fractures different?

Review of results published in the past few years indicates that there are several differences between women sustaining trochanteric fractures or cervical hip fractures. In most series women with trochanteric fractures are older, shorter, and lighter than those with cervical fractures. The bone mineral density was found to be lower in trochanteric fractures, but although in the majority of the studies the diminution was statistically significant at the level of the trochanter and spine—with predominant trabecular bone—the decrease was not uniformly significant at the level of the femoral neck or total skeleton. Previous vertebral fractures were twice as common in patients with trochanteric fractures. Ultrasound exploration of the calcaneus disclosed that the values were significantly lower in women with trochanteric fractures and this finding was independent of the diminution of the bone mineral density. On the other hand, fall biomechanics have not been found to be different in the two types of hip fractures. In summary, women with trochanteric fractures have a more severe and generalized bone loss, especially of the trabecular component. Cervical fractures seem to be more related to pelvic structure—failure of the outer diameter of the femoral neck to expand with age and increased acetabular bone width—added to a focal bone loss. The two main types of fractures should be treated separately in epidemiological or clinical studies to increase the knowledge and the possibilities of preventing hip fractures.