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Hip Fractures Among Older Adults

Hip fractures are serious fall injuries that often result in long-term functional impairment, nursing home admission and increased mortality.1,2 As our population ages, the number of hip fractures is likely to increase.

How big is the problem?

  • In 2010, there were 258,000 hospital admissions for hip fractures among people aged 65 and older.3
  • More than 95% of hip fractures are caused by falling4, most often by falling sideways onto the hip.5
  • From 1996 to 2010, hip fracture rates declined significantly for men and women.6 It is not known what factors are contributing to this trend.
  • By 2030, the number of hip fractures is projected to reach 289,000, an increase of 12%.6
  • In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion.7

What outcomes are linked to hip fractures?

Photo: older woman talking with doctor
  • A large proportion of fall deaths are due to complications following a hip fracture.8  One out of five hip fracture patients dies within a year of their injury.9
  • Treatment typically includes surgery and hospitalization, usually for about one week3, and is frequently followed by admission to a nursing home and extensive rehabilitation.2
  • One in three adults who lived independently before their hip fracture remains in a nursing home for at least a year after their injury.10

Who is at risk?

  • Women sustain three-quarters of all hip fractures.3
  • White women are more likely to sustain hip fractures than are African-American or Asian women.11
  • In both men and women, hip fracture rates increase exponentially with age.12 People 85 and older are 10 to 15 times more likely to sustain hip fractures than are those aged 60 to 65.13
  • Osteoporosis, a disease that makes bones porous, increases a person’s risk of sustaining a hip fracture.14
  • The National Osteoporosis Foundation estimates that more than 10 million people over age 50 in the U.S. have osteoporosis and another 34 million are at risk for the disease.15

How can hip fractures be prevented?

Photo: mother and daughter hugging

Hip fractures can be prevented by preventing falls. Older adults can stay independent and reduce their chances of falling.16,17

To help prevent falls, older adults can:

  • Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good.
  • Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.
  • Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision. Consider getting a pair with single vision distance lenses for some activities such as walking outside.
  • Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways, and improving the lighting in their homes.

To lower their hip fracture risk, older adults can:

  • Get adequate calcium and vitamin D—from food and/or from supplements.
  • Do weight bearing exercise.
  • Get screened and, if needed, treated for osteoporosis.

References

  1. Magaziner J, Hawkes W, Hebel JR, Zimerman SI, Fox KM, Dolan M, et al. Recovery from hip fracture in eight areas of function. Journal of Gerontology: Medical Sciences 2000;55A(9):M498–507.
  2. Marks R, Allegrante JP, MacKenzie CR, Lane JM. Hip fractures among the elderly: causes, consequences and control. Aging Research Reviews. 2003;2:57-93.
  3. National Hospital Discharge Survey (NHDS), National Center for Health Statistics. Available at: http://205.207.175.93/hdi/ReportFolders/ReportFolders.aspx?IF_ActivePath=P,18 Accessed August 29, 2013.
  4. Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Järvinen M. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int, 1999;65:183–7.
  5. Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett HS, Lipsitz LA. Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int 1993;52:192-198.
  6. Stevens JA, Rudd RA. The impact of decreasing U.S. hip fracture rates on future hip fracture estimates. Osteoporosis International 2013. DOI 10.1007/s00198-013-2375-9.
  7. Centers for Disease Control and Prevention. Incidence and costs to Medicare of fractures among Medicare beneficiaries aged >65 years—United States, July 1991–June 1992. MMWR 1996;45(41):877–83.
  8. Deprey SM, Descriptive analysis of fatal falls of older adults in a Midwestern counting in the year 2005. Journal of Geriatric Physical Therapy 2009;32(2):23–28.
  9. Farahmand BY, Michaelsson K, Ahlbom A, Ljunghall S, Baron JA, Swedish Hip Fracture Study Group. Survival after Hip Fracture. Osteoporosis International. 2005;16(12):1583-90.
  10. Leibson CL, Toteson ANA, Gabriel SE, Ransom JE, Melton JL III. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. Journal of the American Geriatrics Society 2002;50:1644–50.
  11. Ellis AA, Trent RB. Hospitalized fall injuries and race in California. Inj Prev 2001;7:316–20.
  12. Samelson EJ, Zhang Y, Kiel DP, Hannan MT, Felson DT. Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study. American Journal of Public Health 2002;92(5):858–62.
  13. Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990;16(3):717–40.
  14. Greenspan WL, Myers ER, Maitland LA, Kido TH, Krasnow MB, Hayes WC. Trochanteric bone mineral density is associate with type of hip fracture in the elderly. Bone and Mineral 1994;9:1889–94.
  15. National Osteoporosis Foundation (NOF). Clinician’s Guide to Prevention and Treatment of Osteoporosis . Available at: www.nof.org/files/nof/public/content/file/344/upload/159.pdf‎.  Accessed August 29, 2013.
  16. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007146. DOI: 10.1002/14651858.CD007146.pub2.
  17. Moyer VA. Prevention of Falls in Community-Dwelling Older Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine 2012;157(3):197–204.
 
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