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 As our population ages, the number of hip fractures is likely to increase.
- In 2007, there were 281,000 hospital admissions for hip fractures among people age 65 and older.2
- Over 90% of hip fractures are caused by falling3, most often by falling sideways onto the hip.4
- In 1990, researchers estimated that by the year 2040, the number of hip fractures would exceed 500,000.5 However, since 2000, the annual number of hip fractures has remained relatively constant.
- From 1990 to 2006, hip fracture rates declined significantly in men age 85 and older and in women age 75 and older.6 It is not known what factors are contributing to this trend.
- In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion.7
- 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 week2, and is frequently followed by admission to a nursing home and extensive rehabilitation.10
- Up to one in four adults who lived independently before their hip fracture remains in a nursing home for at least a year after their injury.11
- Women sustain three-quarters of all hip fractures.2
- White women are much more likely to sustain hip fractures than are African-American or Asian women.12
- In both men and women, hip fracture rates increase exponentially with age.13 People 85 and older are 10 to 15 times more likely to sustain hip fractures than are those age 60 to 65.14
- Osteoporosis, a disease that makes bones porous, increases a person’s risk of sustaining a hip fracture.15 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.16
Hip fractures can be prevented by preventing falls. Fall prevention strategies include:
- Exercising regularly. It’s important that the exercise increase leg strength and improve balance and gradually become more challenging.17 Tai Chi programs are especially good.18
- Asking your doctor or pharmacist to review medicines—both prescription and over-the counter—to identify medicine with side effects and interactions that may cause dizziness or drowsiness.
- Having your vision checked by an eye doctor at least once a year and updating eyeglasses to maximize vision. Consider getting a pair with single vision distance lenses for some activities such as walking outside.
- Making home safety improvements by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding stair railings, and improving lighting.
Additional ways to lower hip fracture risk include:
- Getting adequate calcium and vitamin D in your diet.
- Doing weight bearing exercise.
- Getting screened and treated for osteoporosis.
The most effective way to prevent fall injuries such as hip fractures is to combine exercise with other fall prevention strategies.19
- Stevens JA. Falls Among Older Adults—Risk Factors and Prevention Strategies. In: Falls Free: Promoting a National Falls Prevention Action Plan: Research Review Papers. NCOA Center for Healthy Aging, 2005. pp 3–18.
- National Hospital Discharge Survey (NHDS), National Center for Health Statistics. Accessed August 8, 2010.
- Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985;7:178-208.
- 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.
- Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clinical Orthopedics and Related Research 1990;252:163–6.
- Stevens JA, Rudd RA. Declining hip fracture rates in the United States. Age Ageing. 2010; 39(4);500-503.
- 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.
- 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.
- 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.
- Marks R, Allegrante JP, MacKenzie CR, Lane JM. Hip fractures among the elderly: causes, consequences and control. Aging Research Reviews. 2003;2:57-93.
- 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.
- Ellis AA, Trent RB. Hospitalized fall injuries and race in California. Inj Prev 2001;7:316–20.
- 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.
- Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990;16(3):717–40.
- 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.
- National Osteoporosis Foundation (NOF). Clinician’s Guide to Prevention and Treatment of Osteoporosis. Accessed December 19, 2008.
- Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008 Dec;56(12):2234-43.
- Li, F, Harmer, P, Mack, K, Sleet, et al. Tai Chi: Moving for Better Balance – Development of a Community-Based Falls Prevention Program. J Physical Activity and Health. 2008;5(3):445-55.
- 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.