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What Makes Hip Fractures So Dangerous for the Elderly?


Every year, about 300,000 Americans are hospitalized after fracturing their hip in a fall.1 A hip fracture is difficult to recover from, in part because most patients are elderly. In fact, a study published in 2015 in Mediators of Inflammation revealed 87% to 96% of people who suffer from hip fractures are over 65 years of age.2 Unfortunately the preliminary injury, and often subsequent hip surgery, can lead to a significant decline in independence.

In a 2009 study published in Oxford Academic, just 41% of patients over 90 treated with intensive rehabilitation became fully independent and ambulatory again, while 80% returned to a pre-injury global functional level.3 An overview of various trial studies found the one-year mortality rate for elderly patients with a hip fracture is 21%, and that the 12-year mortality rate doubles once elderly individuals fracture their hips.4

Why is a broken hip so dangerous for an older person? Hip fractures are most often caused by trips, falls off chairs, and other low-energy accidents. Here are some of the factors that put older hip fracture patients in danger:

Lower Bone Density and Muscle Mass

Bone density and muscle mass tend to decrease with age. Osteoporosis is one of the leading factors, is more common in the elderly, and more so in women. The disease causes bones to become weak and brittle and new bone isn’t produced as quickly as older bone tissue is removed. Osteoporosis-related breaks are among the most common types of hip fractures, as bone fractures can occur easily with any type of fall.

Older patients with reduced muscle mass are more at risk of falling due to mobility and balance issues and, subsequently, suffering from a hip fracture.

Presence of Other Conditions

Various medical conditions can put one at risk of a broken hip and impede post-fracture and hip surgery recovery. More prevalent in elderly patients, these include:

  • Diabetes: Type 1 and Type 2 Diabetes reduce bone density. Recovery can be more difficult because of poor bone remodeling, wound healing, and glycemic control, raising the risk of infections and surgical complications.
  • Dementia: Regaining one’s pre-fracture mobility is often a challenge for dementia patients who may not follow recovery protocols and are more prone to falls.
  • Myocardial Infarction: Heart attack patients may have difficulty with producing and transferring clotting agents which will impede healing post-fracture and surgery.
  • Secondary Hyperparathyroidism: Issues with calcium metabolism and regulation may contribute to an injury and how well someone recovers from a hip fracture.
  • Menopause: 70% of hip fractures occur in women5 and lower estrogen levels are linked to weaker bone due to osteoporosis, which, in turn, is linked to problems with other glands.
  • Malnutrition: Poor health and lack of nutrients to promote healing lead to poorer outcomes for elderly patients recovering from a fractured hip.
  • Intestinal Disorders: These can affect one’s ability to absorb calcium and vitamin D and are associated with weakened bones, so they are risk factors before and after a fracture.
  • Neurological Impairment: Dementia, stroke, peripheral neuropathy, and Parkinson’s disease increase an older person’s fall risk.
  • Inactivity: Walking and other weight-bearing exercises help increase bone/muscle strength, reducing fall risk; conversely, a lack of exercise can weaken bones.
  • Medications: Cortical steroids can weaken bone over time. Drugs that act on the central nervous system are often associated with falls, as are any drugs or combinations of medications that cause dizziness.

A patient’s health prior to a fracture is also a consideration. For example, individuals who are less active are prone to reduced cardiorespiratory function, which can complicate recovery. Overall, comorbidities, or other conditions a patient has along with the fractured hip, reduce the body’s reserves for recovery and coping with surgery-related stress.

Body composition is another factor. After hip fracture surgery, patients with a low Body Mass Index (BMI) are more likely to suffer from an adverse cardiac event, be frailer, and have reduced cardiorespiratory function and immunity, further contributing to their risks.

Long Recovery Time

The length of recovery from hip fractures among older patients can increase with age. In general, the older individuals are and the greater number of conditions they have, the longer it can take to recover. The recovery time for a hip replacement ranges from four weeks to up to six months.6

For patients with less dependency before breaking their hip, hospital admission tends to be delayed. However, they are more likely to be assigned to rehabilitation beds in the hospital. Those who are less active before being injured are more likely to be placed in nursing homes.6

The type of injury can affect recovery time as well. Most people with a broken hip suffer one of two types of hip fractures. An intracapsular break involves the top of the femur that fits in the hip’s “ball and socket” joint such an injury can affect the blood supply to this area. An intertrochanteric fracture is a break in the upper femur. It is one form of extracapsular fracture, a category that also includes subtrochanteric fractures, which occur at lower parts of the femur, away from the hip joint capsule.

female nurse helping patient to walk using walker

Risk of Complications

The initial trauma and surgery can pose a high enough risk of complications. Further exacerbating the problem is that a hip fracture can keep a person immobile for quite some time. This can lead to blood clots in the legs or lungs, bedsores, and urinary tract infections. Inactivity can lead to an additional loss in muscle mass, which increases the risk of falling again even if the patient starts to recover.

Several factors can contribute to death after a hip fracture. These range from issues that led to the fall, such as cardiovascular, pulmonary, or neurological issues, to post-surgical complications like infections and pulmonary embolism. Pressure ulcers and pneumonia are more common for patients who are institutionalized than those who are not.

Hip Fracture Symptoms

If you fall or you’re a caretaker for someone who may have fractured his or her hip, here are some symptoms to look for:

  • Severe pain in the hip or groin area
  • Inability to move one’s legs after a fall
  • Bruising, swelling, and stiffness around the hip
  • Inability to bear weight on the injured leg
  • The injured leg turns outward
  • The leg on the side of the injured hip looks shorter

Elderly people with any of these symptoms should seek immediate medical attention. They should also see a hip specialist to determine the extent of the injury and determine the best course of treatment.

Can Hip Fractures Be Prevented?

A combination of factors makes hip fractures particularly dangerous for the elderly, but bone fractures and their consequences don’t have to be inevitable. There are ways to lower people’s risks of breaking their hips in the first place.

The sooner people adopt healthy lifestyle choices, the more they can reduce risk factors for falls and hip injuries later in life. In early adulthood, healthy habits can boost your peak bone mass. Better nutrition and more exercise can limit your risk of developing osteoporosis later. However, adopting good habits at any age can be helpful in improving health and reducing the risk of falling.

Here are some of the most effective preventative measures:

  • Diet: Sufficient levels of vitamin D and calcium are important. Men and women over 50 should get 600 international units of vitamin D and 1,200 milligrams of calcium daily.7
  • Exercise: Weight-bearing exercises help maintain peak bone density, strength, and balance; for older individuals, balance training can help because this often becomes an issue later in life.
  • Eye Exams: Each year, have an eye exam to check for eye problems (if you can’t see, it’s hard to avoid falling); see an eye doctor more frequently if you have diabetes.
  • Avoid Smoking/Excessive Drinking: These activities can affect bone density, and alcohol can impair balance in excess amounts, increasing the risk of falling.
  • Remove Fall Hazards: Misplaced furniture, throw rugs, and exposed electrical cords along high-traffic areas at home are risks; also make sure there’s adequate lighting at home.
  • Watch for Side Effects: If you feel weak or dizzy when taking multiple medications, or after starting a new one, contact your doctor.
  • Be Careful: Stand up slowly, to avoid dangerous drops in blood pressure, or use a walking stick or walker if you feel unsteady while walking.

seniors in the kitchen

Seek Treatment at Crystal Run Healthcare

Our orthopedic surgeons specialize in the latest minimally invasive techniques that lead to less pain, scarring, and hip surgery complications. A faster recovery and more favorable outcome are our goals. Our surgeons can  perform a total hip replacement, anterior hip replacement, hip resurfacing, or hip arthroscopy. From diagnostic imaging to pain management and physical therapy, elderly patients with a broken hip can depend on us for the best care.

To learn more about Crystal Run Healthcare and find a hip specialist, contact us at 845-703-6999, submit your questions online, or request a callback today.