Hip fracture

Date Updated: 03/27/2020

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.

Diagnosis

Often your doctor can determine that you have a hip fracture based on your symptoms and the abnormal position of your hip and leg. An X-ray usually will confirm that you have a fracture and show where the fracture is.

If your X-ray doesn't show a fracture but you still have hip pain, your doctor might order an MRI or bone scan to look for a hairline fracture.

Most hip fractures occur in one of two locations on the long bone that extends from your pelvis to your knee (femur):

The femoral neck. This area is situated in the upper portion of your femur, just below the ball part (femoral head) of the ball-and-socket joint.
The intertrochanteric region. This region is a little farther down from the hip joint, in the portion of your upper femur that juts outward.

Treatment

Treatment for hip fracture usually involves a combination of surgery, rehabilitation and medication.

Surgery

The type of surgery you have generally depends on the where and how severe the fracture is, whether the broken bones aren't properly aligned (displaced), and your age and underlying health conditions. The options include:

Internal repair using screws. Metal screws are inserted into the bone to hold it together while the fracture heals. Sometimes screws are attached to a metal plate that runs down the femur.
Total hip replacement. Your upper femur and the socket in your pelvic bone are replaced with artificial parts (prostheses). Increasingly, studies show total hip replacement to be more cost-effective and associated with better long-term outcomes in otherwise healthy adults who live independently.
Partial hip replacement. If the ends of the broken bone are displaced or damaged, your surgeon might remove the head and neck of the femur and install a metal replacement. Partial hip replacement might be recommended for adults who have other health conditions or cognitive impairment or who no longer live independently.

Your doctor might recommend partial or total hip replacement if the blood supply to the ball part of your hip joint was damaged during the fracture. That type of injury, which occurs most often in older people with femoral neck fractures, means the bone is less likely to heal properly.

Rehabilitation

Your care team will likely get you out of bed and moving on the first day after surgery. Physical therapy will initially focus on range-of-motion and strengthening exercises. Depending on the type of surgery you had and whether you have help at home, you might need to go from the hospital to an extended care facility.

In extended care and at home, you might work with an occupational therapist to learn techniques for independence in daily life, such as using the toilet, bathing, dressing and cooking. Your occupational therapist will determine if a walker or wheelchair might help you regain mobility and independence.

Preparing for an appointment

You may be referred to an orthopedic surgeon.

What to expect

Your doctor might ask:

Have you recently fallen or had another injury to your hip?
How severe is your pain?
Can you put weight on your leg on the side of your injured hip?
Have you had a bone density test?
Have you been diagnosed with any other medical conditions? What medications are you currently taking, including vitamins and supplements?
Do you use alcohol or tobacco?
Have you ever had surgery? Were there any problems?
Do any of your blood relatives — such as a parent or sibling — have a history of bone fractures or osteoporosis?
Do you live independently?