Impact of Socioeconomic Factors on Patient’s Adherence to Lifestyle Modifications Aimed at Reducing Future Fracture Risk in Geriatric Patients With Peritrochanteric Fragility Fractures of the Hip

Introduction A history of fracture is a well-documented risk factor for sustaining future falls and subsequent fractures in geriatric patients. Orthopedic surgeons advocate various lifestyle modifications to reduce the risk of sustaining a recurrent fracture in this vulnerable group. However, it has been observed that patients seldom adhere to this advice and the rate of fragility fractures has thus continued to rise in this vulnerable subset of the population. The factors influencing the compliance of patients with various modifications have not been documented in any previous studies. In our study, we aimed to evaluate the factors influencing patient adherence to various lifestyle modifications advised by orthopedic surgeons for reducing future fracture risk. Material and methods A total of 112 patients aged >65 years who were diagnosed as having a peritrochanteric fragility fracture of the hip and were treated operatively for the same were included in this study. Upon discharge from the hospital, the patients were advised 10 lifestyle modifications to reduce the recurrent fracture risk. A data collecting form that graded the adherence on a 20-point scale (2 points for each lifestyle modification) was prepared by the investigators. Upon the six-month follow-up visit, adherence was assessed on the 20-point scale, and data were collected via the face-to-face interview method. Statistical analysis was accomplished by the Chi-square test and logistic regression analysis. Observations and results Of the 112 subjects included in the study, 58 (51.7%) were male and the mean age was 75 ± 8 (65 - 92) years. The adherence to less than 4 recommendations (Score <8) was seen in 39.2%, adherence to 4 - 6 recommendations (Score between 8 - 12) was seen in 30.86%, adherence to 6 - 8 recommendations (Score between 12 and 16) was seen in 29.94% and adherence to eight to 10 recommendations (score between 16 and 20) was seen in 0% of participants. According to the regression analysis, the presence of adherence to less than six recommendations was related to the low-income level (OR=0.298; 95%CI - 0.132-0.666; p<0.001) and lack of education and awareness (OR=2.329; 95% CI - 1.114-4.859; p=0.002). Conclusion The rates of adherence to advised lifestyle modifications were generally found to be low. Compliance was particularly reduced in patients belonging to the lower socioeconomic strata, which were less likely to be educated and had lower rates of income. The authors concluded that merely advising lifestyle modifications was not enough, and various social and public health measures are required to improve patient compliance, with the broader aim of ending the menace of recurrent fragility fractures.