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 system — 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 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 fractures 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 reducing 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 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.
May 11, 2018
- Foster KW. Hip fractures in adults. https://www.uptodate.com/contents/search. Accessed March 5, 2018.
- Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa.: Mosby Elsevier; 2014. Accessed Dec. 30, 2014.
- AskMayoExpert. Hip fracture. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
- Ferri FF. Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Dec. 30, 2014.
- Reeve J, et al. The fragile elderly hip: Mechanisms associated with age-related strength and toughness. Bone. 2014;61:138.
- Kiel DP. Falls in older persons: Risk factors and patient evaluation. https://www.uptodate.com/contents/search. Accessed March 18, 2018.
- Gruber-Baldini AL, et al. Cognitive differences between men and women who fracture their hip and impact on six-month survival. Journal of the American Geriatrics Society. 2017;65:e64.
- Wirth CD, et al. Subclinical thyroid dysfunction and the risk for fractures: A clinical review and meta-analysis. Annals of Internal Medicine. 2014;161:189.
- Lewiecki EM. Prevention of osteoporosis. http://www.uptodate.com/home. Accessed Dec. 31, 2014.
- Hip fractures among older adults. Centers for Disease Control and Prevention. http://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html. Accessed Dec. 31, 2014.
- Morrison RS, et al. Medical consultation for patients with hip fracture. https://www.uptodate.com/contents/search. Accessed March 5, 2018.
- Takahashi PY (expert opinion). Mayo Clinic, Rochester, Minn. March 8, 2018.
- Azar FM, et al. Arthroplasty of the Hip. In: Campbell's Operative Orthopaedics. 13th ed. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed. March 5, 2018.
- Rosen HN. The use of bisphosphonates in postmenopausal women with osteoporosis. https://www.uptodate.com/contents/search. Accessed March 5, 2018.
- Hip fractures. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00392. Accessed Dec. 31, 2014.
- Fiatarone Singh MA. Exercise, nutrition, and managing hip fracture in older persons. Current Opinion in Clinical Nutrition and Metabolic Care. 2014;17:12.
- Falls and factures. National Institute on Aging. http://www.nia.nih.gov/sites/default/files/falls_and_fractures_0.pdf. Accessed Dec. 31, 2014.
- Osteoporosis: The Bone Thief. National Institute on Aging. http://www.nia.nih.gov/health/publication/osteoporosis. Accessed Dec. 31, 2014.
- Hip fractures. Merck Manual Professional Version. http://www.merckmanuals.com/professional/injuries-poisoning/fractures/hip-fractures. Accessed March 5, 2018.
- Batin S, et al. Evaluation of risk factors for second hip fractures in elderly patients. Journal of Clinical Medicine Research. 2018;10:217.
- Sobolev B, et al. Risk of second hip fracture persists for years after initial trauma. Bone. 2015;75:72.