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Hip Fracture

What is a hip fracture?

A hip fracture is a break in the thigh bone (femur) of your hip joint.

Joints are areas where two or more bones meet. Your hip joint is a "ball and socket" joint, where your thigh bone meets your pelvic bone. The ball part of your hip joint is the head of the thigh bone. The socket is a cup-like structure in your pelvic bone. This is called the acetabulum. Hip fracture is a serious injury and needs immediate medical attention.

The majority of hip fractures happen to people older than age 60. The incidence of hip fractures increases with age, doubling for each decade after age 50. Caucasians and Asians are more likely to be affected than others. This is primarily because of a higher rate of osteoporosis. Osteoporosis (loss of bone tissue) is a disease that weakens bones.

Women are more prone to osteoporosis than men; therefore, hip fracture is more common among women. They experience most hip fractures. More than 1.5 million Americans have fractures annually because of osteoporosis.

Either a single break or multiple breaks can happen in a bone. A hip fracture is classified by the specific area of the break and the type of break(s) in your bone.

The most common types of hip fractures are:

  • Femoral neck fracture. A femoral neck fracture happens 1 to 2 inches from your hip joint. This type of fracture is common among older adults and can be related to osteoporosis. This type of fracture may cause a complication, because the break usually cuts off the blood supply to the head of the thigh bone, which forms the hip joint.  

  • Intertrochanteric hip fracture. An intertrochanteric hip fracture happens 3 to 4 inches from your hip joint. This type of fracture does not usually interrupt the blood supply to your bone and may be easier to repair. 

The majority of hip fractures fall into these 2 categories in relatively equal numbers. Another type of fracture, called a stress fracture of the hip, may be harder to diagnose. This is a hairline crack in the thigh bone that may not involve your whole bone. Overuse and repetitive motion can cause a stress fracture. The symptoms of this injury may mimic those of tendonitis or muscle strain.

What causes a hip fracture?

A fall is the most common reason for a hip fracture among the elderly. A small percentage of people may have a hip fracture happen spontaneously. If you are younger, a hip fracture is generally the result of a car accident, a fall from a great height, or severe trauma.

Hip fracture is more common in older people. This is because bones become thinner and weaker from calcium loss as a person ages. This is generally due to osteoporosis.

Bones affected by osteoporosis are more likely to break if you fall. Most hip fractures that older people get happen as a result of falling while walking on a level surface, often at home.

If you are woman, you lose 30% to 50% of your bone density as you age. The loss of bone speeds up dramatically after menopause, because you produce less estrogen. Estrogen contributes to maintaining bone density and strength.

What are the risk factors for hip fracture?

A risk factor is anything that may increase your chance of developing a disease. It may be an activity, diet, family history, or many other things. Different diseases have different risk factors. Although these factors can increase your risk, they do not necessarily cause the disease. For example, you may have one or more risk factors for a certain disease or condition, but never develop it. On the other hand, you may not have any known risk factors, but develop the disease or condition anyway.

  • Being aware of your risk factors for any disease can help you take appropriate actions, such as changing behaviors and being clinically monitored for the disease.

Osteoporosis is the leading cause of hip fracture. Age is also a major risk factor. Other possible risk factors for hip fracture may include the following:

  • Excessive alcohol consumption
  • Lack of physical activity
  • Low body weight
  • Tall stature
  • Vision problems
  • Dementia
  • Medicines that cause bone loss
  • Cigarette smoking
  • Institutional living, such as an assisted-care facility
  • Increased risk for falls, related to conditions such as weakness, disability, or unsteady gait

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider.

What are the symptoms of a hip fracture?

The following are the most common symptoms of a hip fracture. However, you may experience symptoms differently. Symptoms may include:

  • Hip pain and/or pain that you can feel in your knee
  • Low back pain
  • Inability to stand or walk
  • Bruising and swelling
  • Foot turned out at an odd angle, making your leg look shorter

The symptoms of hip fracture may resemble other medical conditions. Always talk with your healthcare provider for a diagnosis.

How is a hip fracture diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures for hip fracture may include the following:

  • X-ray. Invisible electromagnetic energy beams produce images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI). A combination of large magnets, radiofrequencies, and a computer produce detailed images of organs and structures within your body.
  • Computed tomography scan (also called a CT or CAT scan). This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.

How is a hip fracture treated?

Your healthcare provider will determine specific treatment for hip fracture, based on: 

  • Your age, overall health, and medical history
  • Extent of the condition
  • Your tolerance for specific medicines, procedures, or therapies
  • Expectation for the course of the condition
  • Your opinion or preference

A fracture of your hip is generally treated with surgery. Your surgeon may use metal devices to strengthen and stabilize your joint. In some situations, he or she may do a partial or total hip replacement. The type of surgical repair will depend on the type of hip fracture. Your surgeon will determine the best procedure for you, based on your individual situation. The goal of treatment is to provide relief from pain and enable you to resume your normal activity level. Hip surgery usually requires an in-hospital stay. While in the hospital, you begin doing physical therapy exercises to regain strength and range of motion in your hip. Physical therapy will continue at home or on admission to a rehabilitation facility.

What are the complications of hip fracture?

Serious complications can result from a hip fracture. Blood clots can happen in the veins, usually in your legs. If a clot breaks off, it can travel to a blood vessel in your lung. This blockage, called a pulmonary embolism, can be fatal.

Other complications can include:

  • Pneumonia
  • Muscle atrophy (wasting of muscle tissue)
  • Postoperative infection
  • Nonunion or improper union of your bone
  • Mental deterioration following surgery in older patients
  • Bedsores from lying in the same position with minimal movement

With some fractures, blood cannot circulate properly to the head of the thigh bone. This results in a loss of blood supply to this area. This is called femoral vascular necrosis, or avascular necrosis. This complication may happen, depending on the type of fracture and the anatomy of your blood supply to the head of the thigh bone. This is more common with femoral neck fractures.

Most people spend from 1 to 2 weeks in the hospital after a hip fracture. The recovery period may be lengthy, and may include admission to a rehabilitation facility. If you were previously able to live independently, you will generally need help from home caregivers or family, or need the services of a long-term care facility. Hip fractures can result in a loss of independence, reduced quality of life, and depression. This is especially true for older people.

Can a hip fracture be prevented?

Preventive measures include taking enough calcium every day.

If you are a woman at menopause, you should consider having a bone density test. This measures your bone mineral content and the thickness of your bone. This measurement can indicate decreased bone mass. This is a condition in which your bones are more brittle and more prone to break or fracture easily. A bone density test is used primarily to diagnose osteoporosis and to determine fracture risk.

Women, who sustain the majority of hip fractures, make less estrogen when menopause begins. Most people do not know they have osteoporosis until they sustain a fracture.

Another way to help prevent hip fracture is to engage in regular weight-bearing exercise, such as walking, jogging, or hiking. Exercise programs such as Tai Chi help promote strength and balance.

Other preventive measures may include:

  • Taking medicines as prescribed by your healthcare provider to prevent bone loss
  • Eating a calcium-rich diet, including milk, cottage cheese, yogurt, sardines, and broccoli
  • Stopping smoking
  • Avoiding excessive alcohol use
  • Keeping objects off the stairs and floors, such as electrical cords, to prevent falls
  • Using slip-resistant rugs next to the bathtub, and installing grab bars in the tub
  • Positioning night lights from the bedroom to the bathroom
  • Using rug pads or nonskid backing to keep rugs in place
  • Not using unsteady furniture or step ladders to stand on
  • Visiting an ophthalmologist every year to have vision checked annually and vision loss treated

Key points about hip fracture

The majority of hip fractures happen to people older than age 60. The incidence of hip fractures increases with age, doubling for each decade after age 50. Hip fracture is a serious injury and needs immediate medical attention.

  • A fall is the most common reason for a hip fracture among the elderly.
  • Hip fracture is more common among women.
  • Osteoporosis and advancing age are the major risk factors.
  • A fracture of the hip is generally treated with surgery.
  • Serious complications can result from a hip fracture.
  • Preventing a hip fracture is more desirable than treating one. 
  • Women at menopause should consider having a bone density test.
  • Regular weight-bearing exercise helps to prevent a hip fracture.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Medical Reviewers:

  • Joseph, Thomas N., MD
  • Moloney, Amanda Jane (Johns), PA-C, MPAS, BBA