Review finds common psychiatric and lifestyle risks after young-adult hip fracture

Researchers reviewed literature on adults aged 18–50 years with hip fracture, assessing associated risk factors, functional outcomes beyond 12 months and referral for bone-health assessment. The review included 44 studies; 23 contributed risk-factor data and 26 reported functional outcomes. Only eight studies were specifically designed to investigate risk factors or outcomes in this age group.

Psychiatric disease was reported in 15% of patients (range across studies, 10–23%), alcohol excess in 15% (6–38%) and cigarette smoking in 36% (25–49%). Glucocorticoid exposure was reported in 5% (2–14%) and psychotropic medication exposure in 12% (3–42%). At least 80% had good or excellent functional recovery by 12 months, but up to 15% had poor outcomes at two years. Mortality beyond one year was reported by only one study, and just one study reported bone-health assessment referral data.

The findings highlight substantial evidence gaps, particularly for minimal-trauma fractures and longer-term mortality. More than half of the included studies had moderate or high risk of bias, limiting certainty about the prevalence estimates and outcomes. The review does not establish how often guideline-recommended bone-health assessment is implemented.