Overview

A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age.

Risk increases because bones tend to weaken with age (osteoporosis). Multiple medications, poor vision and balance problems also make older people more likely to 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.

Symptoms

Signs and symptoms of a hip fracture include:

  • Inability to get up from a fall or to walk
  • Severe pain in your hip or groin
  • Inability to put weight on your leg on the side of your injured hip
  • Bruising and swelling in and around your hip area
  • Shorter leg on the side of your injured hip
  • Outward turning of your leg on the side of your injured hip

Causes

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.

Risk factors

The rate of hip fractures increases substantially with:

  • Age. Bone density and muscle mass tend to decrease with age. Older people can also have problems with vision and balance, which can increase the risk of falling.
  • Your sex. Hip fractures occur in women about three times more often than they do in men. Women lose bone density faster 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.
  • Osteoporosis. If you have this condition, which causes bones to weaken, you're at increased risk of fractures.
  • Other chronic medical conditions. Endocrine disorders, such as an overactive thyroid, can lead to fragile bones. Intestinal disorders, which can reduce your absorption of vitamin D and calcium, also can lead to weakened bones.

    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.

    Having low blood sugar and low blood pressure also can contribute to the risk of falls.

  • 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 — are 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. It's also important to get enough calcium and vitamin D in older age to try to maintain the bone you have. As you age, try to maintain a healthy weight. Being underweight increases the risk of bone loss.
  • Physical inactivity. Lack of regular weight-bearing exercise, such as walking, can result in weakened bones and muscles, making falls and fractures more likely.
  • Tobacco and alcohol use. Both can interfere with the normal processes of bone building and maintenance, resulting in bone loss.

Complications

A hip fracture can reduce your independence and sometimes shorten your life. About half the people who have a hip fractures aren't able to regain the 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
  • Bedsores
  • Urinary tract infections
  • Pneumonia
  • Further loss of muscle mass, increasing your risk of falls and injuries
  • Death

Prevention

Healthy lifestyle choices in early adulthood build a higher peak bone mass and reduce your risk of osteoporosis in later years. The same measures adopted at any age might lower your risk of falls and improve your overall health.

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. Exercise also increases your overall strength, making you less likely to fall. Balance training also is 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 can also 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 cane, walking stick or walker. If you don't feel steady when you walk, ask your doctor or occupational therapist whether these aids might help.