The third time my aunt fell down, I asked if I could send her a giant roll of bubble wrap. She said “no,” as that much plastic would cramp her elegant style. I didn’t realize how close we were to the end when yet another fall resulted in a broken hip. Her death certificate says “heart failure,” but the real cause was that hip fracture.
Can preventing a hip fracture really save your life? Hip fractures are often the final insult before the last decline. They decrease mobility, often to the point of complete bed rest. Surgery require recuperation, leading to bed sores, decreased social contact, and increase healthcare costs. The hip fracture often leads to a severe decline in quality of life. As much as twenty percent of the time, the hip fracture leads to an early death.
No one wants to be injured, but as we get older, it is critical to avoid a hip fracture. Hip fractures are the last major insult to an aging body, often leading to a severe health decline and an early death. According to one study, a hip fracture is “perhaps the most dramatic consequence of osteoporosis in the elderly, as it is associated with excess mortality of 5-20%.”
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Even among younger (under 75 years old) individuals, study after study reveals a higher rate of mortality (death) even years after the initial fracture. That is regardless of the health of the individual before the break. In other words, if you are over 50 and you break your hip, you are almost certainly shaving years off your life.
Even if the hip fracture does not kill you, it definitely will ruin your quality of life. Hip fractures require surgery and bed rest. Those, in turn, create muscle weakness and a lack of mobility. Quality of life almost never returns to the pre-fracture status.
Hip fractures are also financial drains that can be the end of your aging-in-place lifestyle. Patients often end up in nursing homes. Treatment includes more than physical therapy. It includes hiring caretakers when you cannot take care of yourself. Insurance rarely reimburses payments to cleaning and cooking aides. It is not likely to cover home modifications for wheelchairs, or moving your bedroom and bathroom to the first floor.
You will pay all these expensive out of your own pocket. If you are lucky enough to have family or friends to help, you will be asking for huge favors. You will need daily medical care and help with meals, as well as help with housekeeping and laundry. Such a large burden can strain your helper’s ability to make a living, and to advance their career. These sacrifices are rarely rewarded with anything other than hardship.
Last but not least it the fact that breaking your hip hurts. Even if you recover and the treatment is a success, the resulting lack of mobility and constant achiness can wear on a person’s soul.
Who is at Risk Hip Fractures
So who is at risk for hip fractures? What are your chances of breaking your own hip?
Hip fractures are primarily associated with age. The older you are, the more likely you are to break your hip.
Many diseases and disorders are associated with more hip fractures as well. For example, dementia patients are sometimes prescribed antipsychotic medications. The longer the patient is on the anti-psychotics, the more likely they are to break their hip.
Weak bones often lead to stress fractures. The ultimate cause is usually osteoporosis, but can also be malignant bone cancer.
Patients with cardiovascular disease (CVD) are at higher risk for hip fracture. Researchers believe this is because osteoporosis and CVD share common causes. CVD is a red flag indicating possible osteoporosis, and therefore a greater risk for hip fracture.
Winter weather is associated with higher rates of hip fractures. Slippery ice causes all kinds of falls, including the kind that breaks hips. Multiple studies have found correlations of hip fractures with lower temperatures, rain, and ice conditions.
Ethnicity can affect the odds of hip fracture. Black, White and Hispanic men are more likely to break their hips than Asian men. However, Black men and women have fewer hip fractures than White men and women. Researchers speculate that these bone density, Vitamin D processing, and age related weight gain creates the different rates of fractures across races.
Women have more hip fractures than men, probably due to their higher rates of osteoporosis.
One of the greatest predictors of falling is having fallen before. Loss of feeling and numbness in the feet are both associated with higher rates of hip fractures. People advised to use a cane or a walker are more likely to fall, as they are already unsteady. More hip breaks are seen in people who rely on others to support them when walking, who push themselves up from chairs, and who have difficulty stepping onto curbs. All are signs of leg weakness and instability.
What exactly is a hip fracture?
The term “broken hip” is actually a misnomer. The hip is a joint (where two or more bones meet) and as such cannot actually break. What actually breaks most often is the femur, which is the “thigh bone.” A hip fracture is a break in the top quarter of the femur.
The femur head is a ball shaped bone. It points into the pelvis at about a 45-degree angle. The head connects to the narrower neck. The head and neck sit atop the rest of the femur. The “greater trochanter” is the outside facing part of this bone. This is what you can feel if you push on the outside of your leg close to your hips.
A femoral neck fracture is a break in the femur where the neck and head meet. Also known as an intracapsular fracture, this kind of hip fracture is most often associated with osteoporosis. It is a dangerous injury because it can cut off the femur’s blood supply. Femoral neck fractures require immediate treatment to avoid damage from the lack of blood supply.
The “lesser trochanter” is a bony bump a little below the “greater trochanter” at the top outside of the leg. A break that occurs anywhere between these two landmarks is called an intertrochanteric fracture and is usually 3-4 inches down from the joint. These breaks do not run the risk of cutting off the blood supply and are much easier to repair.
A break lower down from here is called a subtrochanteric fracture. These often result in the bone breaking into multiple pieces.
Stress fractures of the hip are hairline cracks in the femur and are usually the result of weak bones, overuse, or repetitive strain. Often a patient is unaware of a stress fracture. Without treatment, the break gets worse over time. They continue to use and stress the stressed area. A stress fracture in the hip often feels like tendonitis or muscle pain that only gets worse over time.
What Do Hip Fractures Feel Like?
The pain of a broken hip can be excruciating or mild depending on the circumstance.
The pain is usually in the groin, outer thigh, and buttocks.
You might feel pain when flexing or rotating the hips.
Some people do not even notice a stress fracture. The fracture gets worse over time as a result.
How are Hip Fractures Diagnosed
Pain in the groin and buttocks indicates a possible hip fracture. A stress fracture might not cause pain right away. People with stress fractures often rotate their leg and foot outwards. Sometimes one leg is shorter than the other. Doctors order X-rays to confirm major hip breaks. A doctor will order an MRI or a CT scan if a stress fracture is suspected.
What Causes Hip Fractures
Falling is the most common cause of hip fractures. Falling causes 90% of femoral neck fractures. Common household accidents such as slipping in the bathroom, tripping over rugs and electrical cords, slipping on spills in the kitchen or bath often cause the types of falls that lead to broken hips.
Dizziness or drowsiness often precedes a hip fracture fall. Often medication or low blood pressure creates instability. Any kind of rushing, such as running to the toilet, can put one at risk for a hip fracturing fall. Medications that cause diarrhea can lead to rushing, which can lead to falling. Middle of the night bathroom visits and early morning drowsiness can lead to falls as well.
Osteoporosis is a severe weakening of the bones. A person with osteoporosis can break a hip just from standing on one leg and twisting, the simple action one takes when changing direction. For example, my friend’s mother broke her foot while getting out or a chair and turning to go to the kitchen.
Injuries coming from repetitive movements can cause stress fractures. Cancer can cause weakening bones. Neuromuscular diseases often precede interochanteric fractures.
Less frequently, falling from heights and car crashes cause hip fractures. Avoid ladders, and use seatbelts.
Simply being sad and depressed can lead to falls. Lethargy, inattention and carelessness often accompany these states of mind.
How Doctors Treat Hip Fractures
Doctors use hardware to repair a hip, or replace the hip altogether.
“Internal fixation” is fixing a broken hip with hardware such as pins, screws, and guide wires. The hardware holds the bones together while they heal. Candidates for this type of procedure are those that have no chronic diseases and have good bone density. Older patients who have cardiac, renal or pulmonary conditions might not qualify for internal fixation.
Hip replacement surgery (“arthroplasty”) replaces part of or the entire hip with a prosthetic device. Again being in overall good health and having good bone density is a qualifying factor for this procedure.
The doctor might choose not to treat the hip at all. If the break is stable and not moving (or “displaced”) there might not be a need to operate. If the patient cannot handle the rigors of surgery and anesthesia, the doctor might choose not to treat as well. This is especially true if the patient could not walk, was confined to a wheelchair, or was bedridden before the hip break occurred.
Regardless of surgical outcome, the treatment will often include a lot of bed rest, which is a surprisingly dangerous (in)activity. Bed rest can lead to bedsores. Prevention requires rolling the person from side to side a few times a day, especially if the patient cannot do this on her own.
Bed rest often leads to pneumonia because lack of movement causes fluid accumulation in the lungs. Lack of movement can lead to blood clots and muscle wasting.
Medical Conditions that Preclude Hip Surgery
There are also several other conditions that doctors and hospitals will check for before deciding to operate. They will check the heart and lungs and do blood tests, take urine samples, perform electrocardiograms, and take chest x-rays. They also want to make sure the patient can withstand the anesthesia and breathing tubes.
Life After Hip Surgery
After the operation, the patient gets antibiotics and pain medications. They might not prescribe opioids due to the addiction crisis. Painkillers include high doses of non-steroidal anti-inflammatories (NSAIDs), and possibly blood thinners. Hip patients often wear compression stockings and use compression boots. Post-surgical check ups include suture removal, X-rays, and a ton of physical therapy.
What Can Go Wrong with Hip Fracture Treatments?
On occasion things do not go as planned. If a femoral fixation fails, the patient will usually experience pain in the groin of buttocks area not long after the procedure. Treatment for failed fixation is another fixation surgery, but only in patients with good bone quality. In patients with poor bone quality, the surgeons might opt to perform an arthroplasty (total hip replacement) if the patient is willing to accept limited functionality.
Avascular necrosis can also cause buttocks and groin pain. This condition sometimes reduces hip functionality. Interestingly, patients with normal bone density have an increased risk for avascular necrosis. The avascular necrosis complication is difficult to treat.
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How to Avoid Hip Fractures
There are two main ways to prevent hip fractures. Stay active, and do not fall. Women should ensure healthy Vitamin D3 and calcium levels.
Physical activity is far and away is the best tonic for overall health. Weight-bearing exercise strengthens bones as well as muscles. Daily exercise helps maintain muscle tone and balance. Physical activity creates the strength, tone and balance that prevent falls.
Heavy exercise can be hard on the joints, so moderate exercise will often work better. Regular movement can include Tai Chi, yoga, and low impact aerobic exercises. Many people find exercise success with swimming and ballroom dancing.
Many falls happen due to environmental factors such as tripping and slipping hazards. Fall proofing your home can go a long way to keeping you on your feet and off an operating table. Scan the home for rugs, wires, and other tripping hazards. Clean any areas requiring you to step over things to get across the room. Clear tripping hazards from paths. Move power cords off the floor and onto the wall perimeter. Tape carpet and rug edges to the floor. Install grab bars in showers and other bathroom areas such as next to the commode.
Your doctor might suggest using a walker, cane, or wheelchair. Use a fall mat next to the bed, and replace rugs with heavily padded wall-to-wall carpeting.
Only a few padded garments and airbag devices prevent injury.
Finally, know your limitations. There are medical conditions that can make a person more prone to hip injury, Medication side effects are no joke. So if you have osteoporosis, be careful when changing direction. If you get dizzy spells, go slowly, and use a cane or a walker. If you want to remain independent in your own home, protect yourself from breaking a hip.
Conclusion
A simple hip fracture can easily lead to a slow, painful recovery, and an early death. Avoiding hip fracture is essential to staying independent in our own homes. Remove and repair your home’s trip hazards. Be extra careful if you have osteoporosis.
People Also Ask
Is osteoporosis genetic? 30% of women and 12% of men will get osteoporosis, which is a reduction in bone density leading to fragility. Several genes affect bone mass and there is a decent correlation between having these genes and getting osteoporosis. These include genes responsible for processing Vitamin D, estrogen, and collagen. However, there is little evidence that proves causation. Risk factors also include diet, smoking history, age, and gender.
Do men get osteoporosis? Yes. Twelve percent of men get osteoporosis. As women age, they produce less estrogen. However, as men age, they produce more. Researchers believe that estrogen is protective for men. Lifestyle also contributes to male osteoporosis. Risk factors include drinking alcohol, smoking cigarettes, and not exercising.
Sources
All sources were pulled between August 20 to 29, 2019.
- Hip Fractures, Ortho Info.com
- Stay Independent Brochure, CDC
- Hip fracture outcomes: Quality of life and functional status in older adults living in the community and here
- Deterioration in Quality of Life Following Hip Fracture: A Prospective Study
- Survival after Hip Fracture: Short- and Long-Term Excess Mortality According to Age and Gender
- Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study
- Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study
- Excess mortality attributable to hip fracture in white women aged 70 years and older
- Effect of Hip Fracture on Mortality in Elderly Women: The EPIDOS Prospective Study
- The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study.
- Pelvic Hip Anatomy, LexMedicus
- Hip Anatomy, Arthritis-Health
- Femoral Neck Fracture, Radiopedia
- Antipsychotic Use and the Risk of Hip Fracture Among Older Adults Afflicted With Dementia
- Hip or pelvic fracture, Cancer Therapy Advisor
- Cardiovascular Diseases and Risk of Hip Fracture, JAMA Network
- Seasonal variations in incidence of fractures among elderly people
- Racial and ethnic differences in hip fracture outcomes in men
- Sex-specific and Race-specific Hip Fracture Rates
- Role of genetic factors in the pathogenesis of osteoporosis
- Contribution of Gender‐Specific Genetic Factors to Osteoporosis Risk
- What is Osteoporosis?
- What does it mean to have a genetic predisposition to a disease?
- Genetic regulation of bone mass and susceptibility to osteoporosis
- Bioavailable Estradiol May Be an Important Determinant of Osteoporosis in Men: The MINOS Study
