Effects of anabolic hormone treatment in elderly patients with hip fracture

Abstract

The principal aims of these studies were to investigate the status of hip fracture patients regarding BMD, body composition and some nutritional factors at the time of the fracture and changes in these variables during the postoperative period. A further aim was to determine whether anabolic hormone treatment could had any beneficial effects after a hip fracture.

A retrospective study was conducted on 437 consecutive patients with femoral neck fractures. The rate of deep wound infection was low, 3%, indicating that general prophylactic antibiotic treatment should not be recommended but might be considered when the operation time is prolonged. The mortality rate was more than twice the expected for age, 24% during the first year. Besides senile dementia, high age, male gender, was a low serum albumin on admission good predictors of mortality during the first year after a hip fracture. Twenty-five consecutive patients, with a femoral neck fracture underwent quantitative CT (QCT) at the distal femur and proximal tibia, with mostly trabecular bone, and at the middle femur, with mostly cortical bone. There was no difference in bone mineral density (BMD) between the fractured and the uninjured leg at the time of fracture. Six months postoperatively there was a loss of BMD bilaterally in the trabecular bone, most markedly on the fractured side. Muscle volume decreased on the fractured side but increased on the uninjured side during the six months.

Circulating IGF-I levels generally correlate well with GH secretion in healthy well-nourished patients with normal GH responsiveness. Twenty-three hip fracture patients (mean age 80) and 20 coxarthrotic patients (mean age 77) who underwent a total hip replacement were studied consecutively. The hip fracture patients had lower total body mass, BMD (DXA) and IGF-I levels than the coxarthrotic group on admission. A catabolic state seems to develop after a hip fracture, with a significant decrease in lean body mass and BMD after 6 months. Body weight and IGF-I have influence on BMD. Since GH and anabolic steroids have been used to promote anabolism in a variety of clinical catabolic situations, we evaluated the effects of hormonal intervention with GH or anabolic steroids after a hip fracture in two studies.

A one-year randomised study with the anabolic steroid -nandrolone decanoate, active vitamin D (alphacalcidol) and calcium or calcium alone was performed on 63 women with hip fractures. The treatment Was well tolerated, with few adverse events. QCT measurements showed beneficial effects of anabolic steroids and alphacalcidol on both bone and muscle volume during the first 12 months. Gait speed and Harris' hip score were significantly better in the anabolic group than in the control group after 6 and 12 months.

A double-blind placebo-controlled 12-week study with s.c. daily injections of GH or placebo for 3-4 weeks was performed, on 20 women and men with hip fractures. GH treatment increased the IGF-I levels. The GH treatment had positive effects on total bone mineral content (BMC) (DXA) and on BMC at the distal femur in both legs (QCT) at the end of treatment and 2 months after termination of treatment. GH also preserved lean body mass during treatment without serious side-effects. In conclusion, anabolic hormones seem to have a positive effect on the catabolic state after a hip fracture.