What is a broken hip – How serious is a broken hip?
The hip joint is a ball and socket joint. The ball is part of the thigh bone (femur) and the socket (acetabulum) is part of the pelvis. A hip fracture occurs when the thigh bone is broken just below the point at which it connects to the pelvis. Most hip fractures require surgery to enable the injury to heal.
Hip fractures are common injuries, most often seen in the elderly, particularly in women. This is due to the fact that as we age, there is a tendency to loose some bone strength making us more susceptible to broken bones.
Whilst the surgical treatment for hip fractures is usually successful, most patients require extended periods of rehabilitation in order to return to their normal level of mobility. Due to the fact that many hip fractures occur in elderly people, it may be complicated by the presence of pre-existing medical conditions. For this reason, the recovery may be slower and some patients who previously lived independently may need assistance in the home environment or may need to live in a care facility while recovery is made. All patients will need to use walking aids such as a walking frame or walking stick for several months following the operation.
Not everyone makes a complete recovery from hip fractures. In fact, in the elderly, hip fractures may be a trigger for a decline in health. About 24 percent of hip fracture patients over age 50 die within 12 months after injury because of complications related to the injury and the extended recovery period.
For this reason, the best form of treatment is prevention. The best way to go about preventing a hip fracture is to identify risk factors and address them before the accident happens.
Who is at risk for a broken hip?
A combination of factors may increase your risk of a hip fracture, including:
- Age – The rate of hip fractures increases substantially with age. As you age, your bone density decreases, your vision and sense of balance decline, and your reaction time slows. If you’re inactive, your muscles tend to weaken as you age. All of these factors combined can increase your risk of a hip fracture. Almost 9 out of 10 hip fractures occur in people older than age 65
- Gender – About 80 percent of hip fractures occur in women. Women lose bone density at a faster rate than men do. The drop in oestrogen levels that occurs with menopause accelerates bone loss, increasing the risk of hip fractures as a woman moves beyond menopause. However, men also can develop dangerously low levels of bone density
- Osteoporosis – Osteoporosis is the most significant and well-known risk factor for hip fracture (see next section)
- Chronic medical conditions – medical conditions that may increase your risk of bone fragility include endocrine disorders, such as an overactive thyroid, and intestinal disorders, which may reduce your absorption of vitamin D and calcium
- Certain medications – Some drugs, typically those used for chronic conditions such as high blood pressure and asthma, have a gradual effect on your bone health when you take them long-term
- 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. Serious eating disorders, such as anorexia nervosa and bulimia, can damage your skeleton by depriving your body of essential nutrients needed for bone building
- Physical inactivity – Weight-bearing exercises, such as walking, help strengthen bones and muscles, making falls and fractures less likely. If you don’t regularly participate in weight-bearing exercise, you may have lower bone density and weaker bones. Additionally, prolonged bed rest or immobility can lead to bone loss
- Tobacco and alcohol use – Smoking and excessive consumption of alcohol can interfere with the normal processes of bone building and remodelling, resulting in bone loss
Why do bones weaken – osteoporosis
Osteoporosis occurs when bones lose their strength and density. They become fragile, weak and brittle and can fracture (break) more easily. Osteoporosis particularly affects women after menopause and in their later years, although men are also affected.
Most people show no signs of developing osteoporosis until a fracture occurs. Both men and women can take steps from a young age to avoid developing the condition in later life. Reduce your risk of fractures by taking steps to prevent and treat osteoporosis (or brittle bones) and avoid falls wherever possible. Activity and a healthy diet rich in calcium and vitamin D are both important.
Several factors can place a person at risk of osteoporosis. Risk factors include:
- Family history of osteoporosis (mother, sister or grandmother)
- Inadequate amounts of calcium in the diet
- Low vitamin D levels
- Cigarette smoking
- Alcohol intake of more than two standard drinks per day
- Lack of physical activity
- Early menopause before the age of 45
- Long-term use of medications such as corticosteroids for rheumatoid arthritis and asthma.
Both men and women can take steps from a young age to prevent osteoporosis by making sure that they:
- Have a healthy diet with plenty of fresh fruit, vegetables and grains
- Eat calcium rich foods such as dairy products
- Absorb enough Vitamin D by safe sun exposure
- Avoid smoking
- Limit alcohol consumption to two standard drinks per day
- Do regular weight-bearing and strength-training activities.
The most reliable way to diagnose osteoporosis is to measure bone density using a DEXA scan. This is done with x-ray scans that involve minimal radiation, is accurate and can be used to follow up treatment.
If you have osteoporosis, it is never too late to seek treatment. Treatment can halt bone loss and significantly reduce the risk of fractures. It is important that your doctor excludes other medical conditions that can cause osteoporosis, including vitamin D deficiency.
Medications and treatments are available to strengthen bones and prevent fractures by slowing down bone loss. They may improve bone density in women with osteoporosis after the menopause.
Available medical treatments include:
- Bisphosphonates – such as alendronate, risedronate and zoledronic acid, which can be combined with vitamin D and calcium
- Selective oestrogen receptor modulators (SERMs) – in the form of raloxifene
- Vitamin D and calcium supplements
- Hormone replacement therapy (HRT) – short-term use of oestrogen and progestogen at menopause.
How can I prevent a broken hip?
There are several things you can do to improve bone density and protect against falls which will help to prevent hip fractures. The areas to address include:
- See your doctor
- Exercise
- Diet and lifestyle – particularly V-D and calcium
- Home safety
See your doctor
The best way to begin putting things in place to prevent a broken hip is to see your GP. FIrstly they may review your medications to make sure you are not combining medications which may affect your balance. They will also check your blood pressure to make sure you are not suffering from low blood pressure when standing up which can lead to falls. They may refer you for a bone density scan. If your bone density is low, they may prescribe medications and supplements (Vitamin D and calcium) to help improve this. They may also assess your vision and balance and if necessary make a referral to an optometrist/ophthalmologist or occupational therapist.
Exercise
Weight bearing exercise will help prevent loss of bone density and help to improve muscle strength. Exercise that is beneficial include:
- walking
- jogging
- climbing stairs
- dancing
- weight training
It is important to start slowly and build up over a period of months. Your should talk to your doctor about what type of exercise may be beneficial for you and appropriate if you have any other medical conditions, particularly heart or lung conditions.
Exercise programs to improve balance and subsequently reduce falls have been shown to be beneficial in preventing hip fractures. There are two forms of exercise that have shown to reduce falls through improving balance:
- Otago Exercise Program: The Otago exercise program was designed specifically to prevent falls. This is a progressive home exercise program that includes strengthening and balance exercises. It has been shown to reduce falls in four randomised controlled trials by a research team at the University of Otago medical school. For more information, see your doctor.
- Group-based tai chi — Group tai chi classes have been shown to be useful in preventing falls in the elderly population, but not in those individuals that are particularly frail.
Diet and lifestyle – particularly V-D and calcium
It is important that your diet contains all the requirements for maintaining healthy bone. The most important building blocks for bone are calcium and vitamin D. The following guidelines will help ensure you have adequate levels of Vitamin D and calcium.
Vitamin D
- ensure minimum sun exposure to prevent vitamin D deficiency (ie 5–15 minutes exposure, four to six times per week, being careful not to have overexposure to the sun; a vitamin D supplement of at least 800 IU per day is recommended if sun exposure is not possible)
- consider vitamin D and calcium supplementation (for confirmed cases of vitamin D deficiency, supplement with 3000–5000 IU per day for at least one month)
Calcium
- encourage older people to include foods high in calcium in their diets. Good sources of calcium include:
- Dairy foods – low-fat varieties are available to reduce the risk of weight gain or raised cholesterol levels
- Canned fish with edible bones – for example, sardines
- Daily intake:
- Women under 50 and men under 70 1,000mg calcium per day
- Postmenopausal women and men over 70 – 1,300mg calcium
Quitting smoking and limiting alcohol intake to a recommended dose will help to avoid the harmful effects that these practices have on bone density.
Home safety
The most common way to fracture a hip is by having a fall. For this reason it is important to ensure that the living environment is safe and supportive with regards to avoiding falls. The following list may help as a guide for how to avoid falls in the home:
Stairs
- Ensure the stair ways are well lit and clear of loose objects
- Ensure the stairs are structurally sound with no loose floor boards
- Handrails should be installed particularly on steep or long stair cases
Bathrooms
- Place a slip resistant mat / adhesive strip next to the bathtub for safe exit and entry
- Place non slip mat / adhesive strips on the bath and shower floor
- Install sturdy grab rails on the walls around the bathtub and toilet
Bedrooms
- Keep the floor clear of clutter
- Place a bedside table lamp within easy access
- Install a night-light along the route between the bedroom and the bathroom
Living areas
- Keep electrical and telephone cords out of walkways
- Loose mats or rugs should be securely fixed to the floor
- Floor coverings should be kept in good condition
- Ensure person can get into and out of lounge chair easily
- Ensure that well fitting slippers or shoes are worn around the house
Kitchen
- Ensure kitchen is arranged such that items in the kitchen can be reached without
- bending or upsetting balance
- Use step stools with an attached handrail
- Ensure meals can be easily and safely carried from the kitchen to the dining area
- Use non-slip surfaces where possible
External
- Steps/stairs should have an accessible/sturdy grab rail extending along the full length of the steps/stairs
- Paths around the house should be in good repair, and free of clutter