OhioHealth Online

You can break your hip at any age, but hip fractures are most common in people older than 65. As you age, your bones slowly lose minerals and become less dense. Gradual loss of density weakens bones and makes them more susceptible to a hip fracture.

Women are more likely than men to experience a hip fracture because women lose bone density as they age at a greater rate than men do.

A hip fracture is a serious injury, particularly if you're older, and complications can be life-threatening. Fortunately, surgery to repair a hip fracture is usually very effective, although recovery often requires time and patience.

Signs and symptoms of a hip fracture may include:

• 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

In older adults, a hip fracture is most often a result of a traumatic event, such as falling, and weak bones. In younger adults, major trauma to the hip, such as a sports injury or a car accident, may lead to a hip fracture.

A combination of factors may increase your risk of a hip fracture, including:

• Age. The rate of hip fractures increases substantially with age. As you age, your bone density decreases, your vision and sense of balance decline, and your reaction time slows. If you're inactive, your muscles tend to weaken as you age. All of these factors combined can increase your risk of a hip fracture.

  Each year, more than one-third of Americans older than 65 experience a fall at some point, and nearly 2 million end up in hospital emergency rooms due to those falls. More than 300,000 Americans fracture their hip, and about half of them are older than 80.

• Chronic medical conditions. Osteoporosis is a major risk factors for hip fracture. In osteoporosis, the structure of your bones becomes weaker because your bones don't contain as much calcium and other minerals. A weaker structure makes your bones more prone to a fracture, even with relatively minor trauma.

  Other medical conditions also may lead to bone fragility either by slowing bone formation or by speeding up bone loss. These include endocrine disorders, such as hyperthyroidism; gastrointestinal disorders, which may interfere with calcium and vitamin D absorption; and rheumatoid disorders, which often lead to inactivity and loss of bone mass. Low levels of the sex hormones testosterone and estradiol (a form of estrogen) — a condition known as hypogonadism — are associated with an increased risk of osteoporosis.

  Chronic conditions that affect your nervous system can increase your risk of falling, such as Parkinson's disease and multiple sclerosis. Decreased mental alertness, such as that caused by dementia or depression, also increases the risk of falling.

• Sex. About 80 percent of hip fractures occur in women. Women lose bone density at a faster rate than men do. The drop in estrogen levels that occurs with menopause accelerates bone loss, increasing the risk of hip fractures as a woman moves beyond menopause. However, men also can develop dangerously low levels of bone density.
• Heredity. Genetic factors influence bone size, bone mass and bone density. A family history of osteoporosis or fractures later in life is a strong predictor of low bone mass, although not necessarily of fractures themselves. A small-boned, slender frame may put you at increased risk of osteoporosis. Also, Caucasians and Asians have the highest risk of osteoporosis.
• Nutrition. 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. A high caffeine intake may interfere with the absorption of vitamin D and calcium, resulting in decreased bone density.
• 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 weight-bearing exercise, you may have lower bone density and weaker bones. Additionally, prolonged bed rest or immobility can lead to bone loss.
• Tobacco and alcohol use. Smoking and excessive consumption of alcohol can interfere with the normal processes of bone building and remodeling, resulting in bone loss.

• Medications. Certain medications can accelerate bone loss, increasing your risk of osteoporosis and hip fracture. Long-term use of corticosteroids, such as prednisone, may lower bone mass. Other medications that may contribute to bone loss or to calcium or vitamin D deficiencies if used for long periods of time include anticonvulsants, thyroid medications, and certain diuretics and blood thinners.

  Some research has suggested that the long-term use of proton pump inhibitors to reduce stomach acid is linked with a higher risk of hip fracture, possibly by affecting the way calcium is absorbed. If you're taking these medications, ask your doctor if you need to take additional calcium.

  Some drugs may affect your balance and cause dizziness, including certain blood pressure medications, sedatives, tranquilizers, antidepressants, cold and allergy medications, pain relievers and sleep medications.

• Environmental hazards. Loose rugs, cluttered floors, poor lighting, exposed electrical or telephone cords, and stairs with no handrails may increase your risk of stumbling and falling.

Often your doctor can determine that you have a hip fracture based on your symptoms and by observing the abnormal position of your hip and leg. An X-ray will confirm that you have a fracture and show exactly what part of your hip is fractured.

Most hip fractures occur in one of two locations along your femur, the long bone that extends from your pelvis to your knee:

• The femoral neck. The femoral neck is located in the upper portion of your femur, just below its head, which is the ball part of the ball-and-socket joint.
• The intertrochanteric region. This region is the portion of your upper femur that juts outward.

A hip fracture is a serious injury. Although the fracture itself is treatable, complications can be life-threatening. If you also have an illness that makes it unsafe to undergo surgery to repair your broken hip, your doctor may use a tension system (traction) to allow your hip to heal.

The risk of traction is that it keeps you immobile for a long period, during which time you can develop blood clots in the veins of your legs. You can also develop a blood clot after hip surgery if you don't get up and move around very much. It's possible for a blood clot to become lodged in a pulmonary artery, blocking blood flow to lung tissue. This condition, called pulmonary embolism, can be fatal.

Other risks of traction and being immobile include:

• Bedsores
• Urinary tract infection
• Pneumonia
• Muscle wasting

Additionally, people who've had one hip fracture have a significantly increased risk of having another one.

Surgery is almost always the best hip fracture treatment. Doctors typically use nonsurgical alternatives, such as traction, only if you have a serious illness that makes surgery too risky.

The type of surgery you have generally depends on the part of the hip that fractured, the severity of the fracture and your age. Generally, the better your health and mobility before your hip fracture, the better your chances for a complete recovery from a hip fracture.

Femoral neck fractures
Doctors repair this type of fracture by one of three methods:

• Metal screws. If, after the break, the bone is still properly aligned, your doctor may insert metal screws into the bone to hold it together while the fracture heals. This is called internal fixation.
• Replacement of part of the femur. If the ends of the broken bone aren't properly aligned or they've been damaged, your doctor may remove the head and neck of the femur and replace them with a metal prosthesis. This is known as hemiarthroplasty.
• Total hip replacement. This procedure involves replacing your upper femur and the socket in your pelvic bone with a prosthesis. Total hip replacement may be a good option if arthritis or a prior injury has damaged your joint, affecting its function prior to the fracture.

In general, the older you are the more likely you are to receive a prosthesis. That's because older people aren't likely to wear out a prosthesis and so won't need additional surgery. Also, it's even more important for older adults to get moving again quickly after surgery to prevent serious complications.

Intertrochanteric region fractures
To repair this type of fracture, your doctor usually inserts a metal screw (hip compression screw) across the fracture. The screw is attached to a plate that runs down alongside the femur and is attached with other screws to help keep the bone stable. As the bone heals, the screw allows the bone pieces to compress, so the edges grow together.

Hospital stays after hip fracture surgery generally last less than a week. Afterward, you may continue to meet with a physical therapist. Extended care facility stays are often required for those who can't bear weight on their hip after surgery and who don't have assistance at home.

Medication
While surgery is the primary treatment for a hip fracture, a 2007 study in the New England Journal of Medicine found that once-yearly infusions with the intravenous medication zoledronic acid (Reclast, Zometa) might be helpful in treatment of hip fracture. When zoledronic acid is started within three months of the fracture, the rates of new fractures were reduced and survival odds improved.

You can reduce your risk of a hip fracture by taking steps to prevent osteoporosis and to reduce your risk of falling. Women are more likely than men are to develop osteoporosis, particularly after menopause; however, both women and men can take steps to prevent osteoporosis.

Knowing your bone density
If you're a woman, you may want to have a baseline bone density test at menopause. Women are at a considerably higher risk of low bone density than men are because women lose bone density at a greater rate than men do and because they have a lower starting bone mass. Knowing that your bone density is low can lead you to take steps to increase your bone density and prevent complications such as a hip fracture.

The higher your peak bone mass, the less likely you'll be to have fractures later in life. Maximum peak bone mass depends partly on:

• Your inherited ability to make bone
• The amount of calcium you consume
• Your exercise level

Making the right choices
The process of building bone mass usually peaks in your 30s. After that, you start to lose bone mass. Making the right lifestyle choices during peak bone-mass-building years and afterward contributes to a higher peak bone mass and reduces your risk of osteoporosis in later years.

These steps can help you prevent a hip fracture by slowing bone loss:

• Ensure adequate calcium and vitamin D in your diet. These two substances are important in the process of building bone mass, which peaks around age 30. Calcium can also protect against bone loss. Be sure to get enough calcium and vitamin D. Foods containing calcium include milk and other dairy products; dark green vegetables such as broccoli; citrus fruits; shrimp; canned salmon or sardines; and almonds. Vitamin D helps your body absorb calcium. Your body manufactures vitamin D in your skin using the sun's energy. Fortified foods, such as milk, are another common source of vitamin D.

  If you're considering calcium or vitamin D supplements, ask your doctor about what's an appropriate dose for you. The Recommended Dietary Allowance (RDA) for calcium for men and women age 50 and older is 1,200 milligrams (mg) a day. The RDA for vitamin D is 400 to 600 international units (IU) a day for adults older than 50. The amount of extra calcium you need depends on your age, whether you're taking medications such as corticosteroids, how much milk you drink and other factors. How much supplemental vitamin D you need varies depending on your age, whether or not you have certain chronic medical conditions, how much sunlight exposure you're getting and your intake of vitamin D in foods. Experts suggest getting 10 to 15 minutes twice a week of unprotected sun exposure to ensure adequate levels of vitamin D.

• Exercise to strengthen bones and prevent falls. Weight-bearing exercises, such as walking, apply tension and pressure to your muscles and bones, encouraging your body to increase bone density to meet the additional stress. Exercise also increases your overall balance and strength, making you less likely to fall. High-impact exercises, such as those involving running or jumping, aren't recommended if you have weak bones, as they may increase your risk of a fracture or injury. To prevent osteoporosis, exercise at least three times a week for 30 minutes a session.
• Don't drink excessively or smoke. Preserve your bone density by avoiding the excessive use of alcohol and by not smoking.
• Medical treatment of osteoporosis. Your doctor may prescribe a bisphosphonate — such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva) or zoledronic acid (Zometa, Reclast) — to prevent or treat postmenopausal osteoporosis. Raloxifene (Evista) is a selective estrogen receptor modulator and can also be used to prevent or treat postmenopausal osteoporosis. Calcitonin is a naturally occurring hormone involved in bone growth, and when taken as an injection or nasal spray, can be used to treat osteoporosis. Teriparatide (Forteo), an injectable form of human parathyroid hormone, stimulates new bone growth in the spine and hips. It also reduces the risk of vertebral and nonvertebral fractures in women and vertebral fractures in men.

Falls: Reduce your risk
These steps can help you guard against hip fracture by reducing your risk of falls:

• Fall-proof your home. Keep your home well lit and free of hazards that might cause you to trip and fall. Avoid area rugs and exposed electrical cords. Place furniture where you're unlikely to bump into it. Consider installing grab bars in your bathroom, stair treads on steps and handrails along stairways. Use nonslip mats on the bathtub and on shower floors.
• Wear sensible shoes. If you're older, wear thinner, hard-soled, flat shoes. Resilient-soled athletic shoes may impair your balance and contribute to falls. Avoid wearing high heels or sandals with light straps. Avoid wearing shoes that are either too slippery or too sticky.
• Avoid strenuous and dangerous activities. Don't stretch to reach high places. Use a stepladder or ask for help. Avoid lifting heavy objects, climbing and engaging in unusually vigorous activities.
• See your eye doctor. Poor eyesight is a possible cause of falls. Have your eyes checked at least once a year, or sooner if you're having trouble seeing. Wearing proper glasses and being able to see well around your home makes it more likely that you'll see objects that you might trip over.
• Be mindful of side effects of medications. Feeling weak and dizzy, which are possible side effects of many medications, can increase your risk of falling. Talk to your doctor about side effects caused by your medications.

Hip protectors
Another step that won't prevent you from falling but may protect you if you do is to wear a hip protector. These padded, externally worn protectors are similar to what hockey players wear to avoid injury. However, one study found that these devices probably weren't effective at preventing hip fractures.

Recovering from a hip fracture involves a lengthy period of rehabilitation. The goal of rehabilitation is to help you regain mobility. You'll learn how to gradually place more weight on your hip until it can handle your full weight without pain. You'll also learn how to sit, stand and walk so that you don't re-injure your hip or damage your prosthesis, if you have one.

Help with walking and other activities
After a hip fracture, you'll need the help of a walking aid, such as a cane, walker or crutches, for a while. You may also need help getting around your home and doing daily tasks, such as bathing, dressing and cooking. Or, you may need to enter an extended care facility while recuperating to get assistance that's not available at home.

You can help speed the healing process and increase your chances for a full recovery by following your doctor's and therapist's instructions and taking good care of yourself.