The femoral neck is the commonest site of fractures in the elderly.

The vast
majority of patients are Caucasian women in the seventh and eighth decades, and the
association with osteoporosis is so manifest that the
incidence of femoral neck fractures has been used as a measure of age-related
osteoporosis in population
studies. Other risk factors include bone-losing or
bone-weakening disorders such as osteomalacia, diabetes, stroke (disuse),
alcoholism and chronic debilitating disease. In addition, old people often have
weak muscles and poor balance resulting in an increased tendency to fall. The
association of femoral neck fracture with postmenopausal bone loss has stimulated
renewed interest in screening for osteoporosis and prophylactic measures in the ‘at
risk’ population (see Chapter 7). By contrast, this injury is much less common
among people whose bone mass is above that of the population average, e.g. those
with osteoarthritis of the hip. Femoral neck fractures are also much less common in
black (Negroid) peoples than in whites and Asians. The reasons for this phenomenon
are poorly understood. Slightly higher bone mass and a slower rate of bone loss
after the menopause may be significant, but a qualitative difference in bone
structure has also been suggested: even among people with the same bone mass, those
with greater loss of trabecular interconnectivity (typical in elderly whites) will
suffer fractures more easily than those with firmer structure. The incidence of
femoral neck fractures is set to double over the next 30 years; this is a reflection
of a higher number of individuals living beyond 65 years and a parallel rise in
those affected with osteoporosis. The economic impact of treating, rehabilitating
and caring for this group of patients is increasingly being recognized, with many
governments and healthcare administration bodies focusing on preventive strategies.