A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age.
Older people are at a higher risk of hip fracture because bones tend to weaken with age (osteoporosis). Multiple medications, poor vision, and balance problems also make older people more likely to trip and fall — one of the most common causes of hip fracture.
A hip fracture almost always requires surgical repair or replacement, followed by physical therapy. Taking steps to maintain bone density and avoid falls can help prevent a hip fracture.
Signs and symptoms of a hip fracture include:
- Inability to move immediately after a fall
- Severe pain in your hip or groin
- Inability to put weight on your leg on the side of your injured hip
- Stiffness, bruising and swelling in and around your hip area
- Shorter leg on the side of your injured hip
- Turning outward of your leg on the side of your injured hip
A severe impact — in a car crash, for example — can cause hip fractures in people of all ages. In older adults, a hip fracture is most often a result of a fall from a standing height. In people with very weak bones, a hip fracture can occur simply by standing on the leg and twisting.
The rate of hip fractures increases substantially with:
- Age. Bone density and muscle mass tend to decrease with age. Older people also may have problems with vision and balance, which can increase the risk of falling.
- Your sex. About 70 percent of hip fractures occur in women. Women lose bone density at a faster rate than men do, in part because the drop in estrogen levels that occurs with menopause accelerates bone loss. However, men also can develop dangerously low levels of bone density.
- Chronic medical conditions. Endocrine disorders, such as an overactive thyroid, can lead to fragile bones. Intestinal disorders, which may reduce your absorption of vitamin D and calcium, also can lead to weakened bone and hip fracture.
Medical conditions that affect the brain and nervous system, including cognitive impairment, dementia, Parkinson’s disease, stroke, and peripheral neuropathy, also increase the risk of falling.
- Certain medications. Cortisone medications, such as prednisone, can weaken bone if you take them long term. Certain drugs or certain combinations of medications can make you dizzy and more prone to falling. Drugs that act on your central nervous systems — such as sleep medications, antipsychotics, and sedatives, including benzodiazepines — are the drugs most commonly associated with falls.
- Nutritional problems. Lack of calcium and vitamin D in your diet when you’re young lowers your peak bone mass and increases your risk of fracture later in life. Serious eating disorders, such as anorexia nervosa and bulimia, can damage your skeleton by depriving your body of essential nutrients needed for bone building.
- Physical inactivity. Weight-bearing exercises, such as walking, help strengthen bones and muscles, making falls and fractures less likely. If you don’t regularly participate in the weight-bearing exercise, you may have lower bone density and weaker bones.
- Tobacco and alcohol use. Both can interfere with the normal processes of bone building and maintenance, resulting in bone loss.
A hip fracture can reduce your future independence and sometimes even shorten your life. About half the people who have a hip fracture aren’t able to regain their ability to live independently.
If a hip fracture keeps you immobile for a long time, the complications can include:
- Blood clots in your legs or lungs
- Urinary tract infection
- Further loss of muscle mass, increasing your risk of falls and injury
Additionally, people who’ve had a hip fracture are at increased risk of weakened bones and further falls — which means a significantly higher risk of having another hip fracture.
Healthy lifestyle choices in early adulthood build a higher peak bone mass and reduce your risk of osteoporosis in later years. The same measures may lower your risk of falls and improve your overall health if you adopt them at any age.
To avoid falls and to maintain healthy bone:
- Get enough calcium and vitamin D. As a general rule, men and women age 50 and older should consume 1,200 milligrams of calcium a day, and 600 international units of vitamin D a day.
- Exercise to strengthen bones and improve balance. Weight-bearing exercises, such as walking, help you maintain peak bone density for more years. Exercise also increases your overall strength, making you less likely to fall. Balance training is also important to reduce your risk of falls since balance tends to deteriorate with age.
- Avoid smoking or excessive drinking. Tobacco and alcohol use can reduce bone density. Drinking too much alcohol also can impair your balance and make you more likely to fall.
- Assess your home for hazards. Remove throw rugs, keep electrical cords against the wall, and clear excess furniture and anything else that could trip you. Make sure every room and passageway is well-lit.
- Check your eyes. Have an eye exam every other year, or more often if you have diabetes or an eye disease.
- Watch your medications. Feeling weak and dizzy, which are possible side effects of many medications, can increase your risk of falling. Talk to your doctor about the side effects caused by your medications.
- Stand up slowly. Getting up too quickly can cause your blood pressure to drop and make you feel wobbly.
- Use a walking stick or walker. If you don’t feel steady when you walk, ask your doctor or occupational therapist whether these aids might help.
Often your doctor can determine that you have a hip fracture based on your symptoms and the abnormal position of your hip and leg. An X-ray usually will confirm that you have a fracture and show exactly where the fracture is on your bone.
If your X-ray doesn’t show a fracture but you still have hip pain, your doctor may order an MRI or bone scan to look for a small hairline fracture.
Most hip fractures occur in one of two locations on the long bone that extends from your pelvis to your knee (femur):
- The femoral neck. This area is located in the upper portion of your femur, just below the ball part (femoral head) of the ball-and-socket joint.
- The intertrochanteric region. This region is a little farther down from the actual hip joint, in the portion of your upper femur that juts outward.
The third type of hip fracture called an atypical fracture can occur in people who have been treated for a long period of time with medications that enhance bone density (bisphosphonates).
Treatment for hip fracture usually involves a combination of surgery, rehabilitation, and medication.
The type of surgery you have generally depended on the location and severity of the fracture, whether the broken bones aren’t properly aligned (displaced fracture), and your age and underlying health conditions. The options include:
- Internal repair using screws. Metal screws are inserted into the bone to hold it together while the fracture heals. Sometimes screws are attached to a metal plate that runs down the femur.
- Total hip replacement. Your upper femur and the socket in your pelvic bone are replaced with prostheses. Increasingly, studies show total hip replacement to be more cost-effective and associated with better long-term outcomes in otherwise healthy adults who live independently.
- Partial hip replacement. If the ends of the broken bone are displaced or damaged, your surgeon may remove the head and neck of the femur and install a metal replacement (prosthesis). Partial hip replacement may be recommended for adults who have other health conditions or cognitive impairment or who no longer live independently.
Your doctor may recommend partial or total hip replacement if the blood supply to the ball part of your hip joint was damaged during the fracture. That type of injury, which occurs most often in older people with femoral neck fractures, means the bone is less likely to heal properly.
Your care team will probably get you out of bed and moving on the first day after surgery. Physical therapy will initially focus on range-of-motion and strengthening exercises. Depending on the type of surgery you had and whether you have assistance at home, you may need to go from the hospital to an extended care facility.
In extended care and at home, you may work with an occupational therapist to learn techniques for independence in daily life, such as using the toilet, bathing, dressing and cooking. Your occupational therapist will determine if a walker or wheelchair may help you regain mobility and independence.
Up to 10 percent of adults age 65 or older who have a hip fracture will have another hip fracture within two years. Bisphosphonates and other medications for osteoporosis may help reduce the risk of a second hip fracture. To avoid side effects that may make oral bisphosphonates difficult to tolerate, your doctor may recommend taking them via intravenous (IV) tubing.
Bisphosphonates generally aren’t recommended for people with kidney problems. Rarely, long-term bisphosphonate therapy might cause pain and swell in the jaw, vision problems, or an atypical hip fracture.