Elderly women are more prone to develop hip fracture due to?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Medical & Surgical Nursing

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Explanation

Estrogen plays a vital protective role in maintaining bone density by regulating the bone remodeling process.
It inhibits osteoclasts, the cells responsible for bone breakdown, and promotes the activity of osteoblasts, the cells that form new bone.
Following menopause, the sharp and significant decline in estrogen levels leads to an increase in osteoclast activity.
This results in an imbalance where bone resorption (breakdown) outpaces bone formation, leading to accelerated bone loss.
This progressive loss of bone mass and structural integrity is known as postmenopausal osteoporosis, which makes bones fragile and highly susceptible to fractures, particularly in the hip, spine, and wrist.

Option B: Increased bone density is protective against fractures. The condition that predisposes elderly women to fractures is osteoporosis, which is characterized by decreased, not increased, bone density.
Option C: Increased calcium absorption would lead to stronger bones and a lower risk of fracture. In reality, aging is often associated with decreased efficiency of calcium absorption from the gut, which contributes to bone loss.
Option D: While a sedentary lifestyle is a significant risk factor for developing osteoporosis in both men and women, it is not the most specific reason for the disproportionately high rate of hip fractures in elderly women compared to elderly men. The primary differentiating factor is the rapid, hormone-driven bone loss associated with menopause.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology of postmenopausal osteoporosis and its link to fracture risk as background academic context rather than a clinical decision trigger.
Nurses are central to identifying at-risk individuals by assessing risk factors and recommending bone mineral density (BMD) testing (DEXA scan) for all women aged 65 and older.
Patient education is a critical nursing intervention. This includes counseling on a diet rich in calcium (1200 mg/day) and vitamin D (800–1000 IU/day), the importance of regular weight-bearing exercise (like walking), and strategies for fall prevention.
Nurses administer medications for osteoporosis, such as bisphosphonates, and must educate patients on proper administration to ensure efficacy and prevent side effects (e.g., taking with a full glass of water and remaining upright).

How to Approach the Question

First, identify the key elements of the question: the population ('Elderly women') and the condition ('hip fracture'). The question asks for the cause ('due to').
Recognize that the question is asking for the specific reason why this demographic is particularly 'prone' to this issue, implying a factor that is more significant in women than in men.
Evaluate each option based on this understanding:
A) 'Decreased estrogens secretion' is a major physiological event (menopause) unique to aging women and is well-known to affect bone health.
B) 'Increased bone density' is the opposite of what causes fractures; it prevents them.
C) 'Increased calcium absorption' is also a protective factor, not a cause of weakness.

Concept Tested & Keywords

Concept Tested: Pathophysiology of postmenopausal osteoporosis and its link to fracture risk.
Stem keywords: Elderly women, hip fracture, prone to develop
Lead-in keywords: due to
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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E6 Medicine Harrison 22e Part 2 p. 1199-1201

E6 Gynecology Williams pp. 72-95, 76-96