What is a hip fracture?

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.

Prevention

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.

Hormone replacement therapy during menopause: What to do

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.

Women's screening tests: What, why and how often? Canes, walkers and crutches: Choosing what's right Falls: Reduce your risk Perimenopause: A period before your period ends Resolving to exercise? Jump-start your program Aerobic exercise: Why and how

Self-care

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.

Senior Health Center

— July 18, 2002 —