Are bone growth stimulators used in the treatment of elderly hip fractures?

Bone Growth Stimulators Are Not Recommended for Elderly Hip Fractures

Bone growth stimulators are not recommended for routine use in the treatment of elderly hip fractures based on current clinical guidelines and evidence. 1

Evidence Against Bone Growth Stimulators in Hip Fractures

• Low intensity pulsed ultrasound (LIPUS) bone growth stimulation has been shown to have little or no impact on time to return to work, time to full weight bearing, pain, number of subsequent operations, or time to radiographic healing across various fracture types 1
• The BMJ clinical practice guideline (2017) strongly recommends against the use of LIPUS for bone healing, noting that all or nearly all informed patients would elect not to use this intervention 1
• Current hip fracture management guidelines for elderly patients focus on surgical fixation, early mobilization, and comprehensive rehabilitation rather than bone stimulation technologies 1
• No specific recommendations for bone growth stimulators appear in major guidelines for management of elderly hip fractures 1

Current Standard of Care for Elderly Hip Fractures

• Management focuses on prompt surgical intervention, followed by early mobilization and rehabilitation to restore pre-fracture mobility and independence 1
• Orthogeriatric co-management is recommended for frail elderly patients with multiple comorbidities and polypharmacy 1
• Rehabilitation programs should include early post-fracture physical training, muscle strengthening, and long-term balance training 1
• Nutritional support, particularly oral nutritional supplements, is recommended to improve outcomes in elderly hip fracture patients 1

Limited Applications of Bone Growth Stimulation

• Bone growth stimulators (electrical and ultrasound) have shown some benefit in specific scenarios:
  • Treatment of established non-unions in long bones 2, 3
  • As an adjunct for lumbar spine fusion procedures, particularly in high-risk patients 1
  • For non-operatively treated fractures or fractures of the upper limb 4
• However, these benefits have not been demonstrated specifically for acute hip fractures in elderly patients 1, 4

Potential Drawbacks of Bone Growth Stimulators

• LIPUS devices can be cumbersome to travel with and may present practical challenges for elderly patients 1
• Health insurance may not cover the cost, making it a poor use of healthcare resources 1
• Patient compliance with bone stimulator protocols can be limited, as reflected in clinical trials 1
• No evidence of mortality benefit has been demonstrated with bone stimulation technologies 1, 4

Conclusion

For elderly patients with hip fractures, the focus should be on established treatment protocols including appropriate surgical fixation, early mobilization, fall prevention, nutritional support, and comprehensive rehabilitation 1. The current evidence does not support the routine use of bone growth stimulators in this population 1. Healthcare resources are better directed toward evidence-based interventions that have demonstrated improvements in mobility, independence, and quality of life for elderly hip fracture patients.