Alzheimer's Disease and Risk of Proximal Femur Fractures in Elderly: A Systematic Review on Fall Mechanisms and Orthopedic Impacts

Abstract

Brazil’s accelerated demographic transition has led to a rising prevalence of neurodegenerative diseases such as Alzheimer’s Disease (AD), significantly increasing the risk of falls and proximal femur fractures in older adults. This study presents a systematic review analyzing the association between AD, fall risk, and proximal femoral fractures, with emphasis on biomechanical mechanisms and orthopedic outcomes. The review included 23 studies, highlighting that AD substantially increases the risk of low-energy falls, typically occurring indoors and at night, resulting in intertrochanteric and femoral neck fractures. Major risk factors include osteoporosis, sarcopenia, polypharmacy, and cognitive and motor deficits. Fractures in AD patients are associated with high morbidity and mortality rates—up to 50% do not regain pre-fracture functionality, and one-year mortality may reach 30%. Early surgical intervention, fall prevention strategies, and integrated ortho-geriatric care models are essential to mitigate the clinical and social consequences of these fractures in cognitively impaired elderly populations.