You can break your hip at any age, but 90 percent of hospitalizations for hip fractures are for people older than age 65. As you age, your bones become less dense as they slowly lose minerals. Gradual loss of density weakens bones and makes them more susceptible to a fracture.

More than 320,000 Americans are hospitalized for a hip fracture every year. Doctors expect that number to grow as the U.S. population ages. If you're a woman, you're two to three times more likely than a man to experience a hip fracture. That's because women lose bone density 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. Most people, even those older than age 80, make a good recovery from a hip fracture. Generally, the better your health and mobility, the better your chances for a complete recovery.

Hip fractures (click to enlarge)

Signs and symptoms of a hip fracture may include:

The direct cause of a hip fracture often is an accident or a fall, even a relatively minor fall. The underlying cause, especially as you get older, is likely to be osteoporosis.

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. Loss of bone strength tends to be greatest in your spine, lower forearms and upper thighbones (femurs), the site of hip fractures.

Because women lose bone density at a greater rate than men do, they're two to three times more likely to experience a hip fracture. However, men also can develop osteoporosis, and those who do are at greater risk of a hip fracture. The drop in estrogen levels in women that occurs with menopause accelerates bone loss, increasing the risk of hip fractures as they age past menopause.

Osteoporosis (click to enlarge)

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.

Ninety percent of 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 place you in traction to allow your hip to heal.

The risk of traction is that it keeps you immobile for a long period, during which you can develop blood clots in 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 lung artery, blocking blood flow to lung tissue. This condition, a pulmonary embolism, can be fatal unless treated promptly.

Other risks of traction and being immobile include:

• Bedsores
• Urinary tract infection
• Pneumonia

Surgery is almost always the best way to repair a hip fracture. 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.

Doctors repair this type of fracture by one of three methods:

• Metal screws. If, following 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, for fractures where bones aren't well aligned, the older you are the more likely you are to receive a prosthesis. Internal fixation is used more in younger people and for fractures that are well aligned.

To repair this type of fracture, your doctor usually inserts a metal screw (compression hip 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.

Remaining inactive and in bed following hip surgery can increase your risk of serious complications, including the development of blood clots and pneumonia. For that reason, you'll likely be getting up and around as soon as possible.

On the first day after hip surgery you'll likely be moved to a sitting position in a chair. You may even stand or walk a little. Most people who were able to walk prior to a hip fracture are on their feet again within a couple of days.

Hospital stays following hip fracture surgery generally last less than a week. Afterward, you may continue to meet with a physical therapist.

Hip fracture repair techniques (click to enlarge)

You can reduce your risk of a hip fracture by taking steps to prevent osteoporosis, a major underlying cause of hip fractures. Although women are much more likely to have osteoporosis, it's common in both men and women. About 8 million American women and 2 million American men have osteoporosis. Both women and men can take steps to prevent osteoporosis.

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 (osteoporosis) than men are because women lose bone density at a greater rate than men do. 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 and your exercise level. The process of building bone mass peaks at about age 30. After age 30, you start to lose bone mass. Making the right lifestyle choices during peak bone-mass-building years and afterwards may contribute to a higher peak bone mass and reduce 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 at age 30. Be sure to get enough calcium and vitamin D. Calcium can also protect against bone loss. 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.

  If you're considering calcium or vitamin D supplements, ask your doctor about an appropriate level for you. The Recommended Dietary Allowance (RDA) for calcium for men and women age 51 and older is 1,200 milligrams (mg) a day. Some experts recommend 1,500 mg of calcium a day for men older than 65 and for postmenopausal women not taking hormone replacement therapy. The RDA for Vitamin D is 10 micrograms (mcg) a day for adults ages 51 to 70 and 15 mcg a day for adults age 71 and older. The amount of 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 vitamin D you need varies with how much sunlight you're getting and your intake of vitamin D in foods.

• Keep active. 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. If you're younger or middle-aged, high-impact aerobic activities may help increase your bone density. However, if you're older, high-impact exercises may increase your risk of a fracture.
• Don't smoke. Smoking results in a loss of bone density. Smoking increases bone loss, perhaps by decreasing the amount of estrogen your body makes and reducing the absorption of calcium in your intestine. In addition, smokers tend to enter menopause earlier than nonsmokers.
• Consider hormone replacement therapy (HRT). Most women who take HRT during menopause and beyond use a combination of estrogen and a progestin. Estrogen helps maintain bone density. HRT slows the loss of calcium from your bones after menopause, when you experience declining levels of estrogen. Combined with exercise and adequate dietary calcium, HRT protects against osteoporosis and reduces your risk of fractures. But not all effects of HRT are positive. HRT increases your risk of blood clots and gallbladder and heart diseases. And taking HRT as a combination therapy — estrogen with medroxyprogesterone acetate (such as Prempro) — for several years or more may increase your risk of breast cancer. All combination HRT regimens can cause irregular vaginal bleeding, particularly during the first year of use. Further study is needed to determine to what extent estrogen-only therapy increases your risk of breast cancer. The long-term benefits of HRT are therefore under intense scrutiny.

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 situations 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.
• 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. If you're having trouble seeing, have your eyes checked. 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 or 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.

Another effective 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. A study in the New England Journal of Medicine reported that among ambulatory older adults, wearing hip protectors reduced the risk of a hip fracture from a fall by more than 60 percent.

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.

Following a hip fracture, you'll need the help of a walking aid, such as a cane, walker or crutches, for several months. You may also need help getting around your home and doing daily tasks, such as bathing, dressing and cooking. About half of people older than age 65 who break a hip enter an extended-care facility while recuperating because they need assistance that's unavailable 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.

Additional Resources

• American Academy of Orthopaedic Surgeons

• American Occupational Therapy Association

DS00185

July 18, 2002

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