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A hip fracture is a break in the femur (thigh bone) of the hip joint. Joints are areas where two or more bones meet. The hip joint is a "ball and socket" joint where the femur meets the pelvic bone. The ball part of the hip joint is the head of the femur, and the socket is a cup-like structure in the pelvic bone called the acetabulum. Hip fracture is a serious injury and requires immediate medical attention.
A fracture is a partial or complete break in a bone. There can be either a single break or multiple breaks in a bone. A hip fracture is classified by the specific area of the break and the type of break(s) in the bone.
The most common types of hip fractures are:
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- femoral neck fracture
A femoral neck fracture occurs one to two inches from the hip joint. These fractures are 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 femur which forms the hip joint.
- intertrochanteric hip fracture
An intertrochanteric hip fracture occurs three to four inches from the hip joint. This type of fracture does not interrupt the blood supply to the bone and may be easier to repair.
Around 90 percent of hip fractures fall into these two 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 femur that may not involve the whole bone. Overuse and repetitive motion can cause a stress fracture. The symptoms of this injury may mimic those of tendonitis or muscle strain.
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About 90 percent of hip fractures happen to people over 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 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 about 80 percent of all hip fractures. More than 1.5 million Americans have fractures annually because of osteoporosis.
The number of hip fractures in the US is the highest in the world with approximately 300,000 occurrences each year. In 2003, there were about 309,500 hospitalizations for hip fractures. It is estimated that the number could exceed 500,000 by the year 2040.
People who sustain a hip fracture are more likely to die than a person of the same age who does not experience this injury. About 20 percent of people who have a hip fracture die within a year of their injury. It is estimated that only one in four persons have a total recovery from a hip fracture.
Most people spend from one to two weeks in the hospital after a hip fracture. The recovery period may be lengthy, and may include admission to a rehabilitation facility. People who previously were able to live independently will generally need help from home caregivers, family, or may require the services of a long-term care facility. Hip fractures can result in a loss of independence, reduced quality of life, and depression, especially in older people.
A fall is the most common reason for a hip fracture among the elderly. A small percentage of people may have a hip fracture occur spontaneously. In younger people, 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 because bones become thinner and weaker from calcium loss as a person ages, generally due to osteoporosis. Bones affected by osteoporosis are more likely to break if a person falls. Most hip fractures sustained by older people occur as a result of falling while walking on a level surface, often at home.
As they get older, women lose 30 percent to 50 percent of their bone density (thickness). The loss of bone speeds up dramatically after menopause because women produce less estrogen. Estrogen contributes to maintaining bone density and strength.
A risk factor is anything that may increase a person's 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 a person's risk, they do not necessarily cause the disease. For example, some people with one or more risk factors for a certain disease or condition never develop it, while others develop the disease or condition and have no known risk factors.
Knowing your risk factors to any disease can help to guide you into the appropriate actions, including 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, but are not limited to, the following:
- excessive alcohol and caffeine consumption
- lack of physical activity
- low body weight
- tall stature
- vision problems
- medications 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 upon your specific medical condition. Be sure to discuss any concerns with your physician.
The following are the most common symptoms of a hip fracture. However, each individual may experience symptoms differently. Symptoms may include:
- hip pain and/or pain that can be felt in the knee
- low back pain
- inability to stand or walk
- bruising or swelling
- foot turned out at an odd angle, making the leg look shorter
The symptoms of hip fracture may resemble other medical conditions. Always consult your physician for a diagnosis.
In addition to a complete medical history and physical examination, diagnostic procedures for hip fracture may include the following:
- x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
- computed tomography scan (Also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard x-rays.
Specific treatment for hip fracture will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the condition
- your tolerance for specific medications, procedures, or therapies
- expectation for the course of the condition
- your opinion or preference
A fracture of the hip is generally treated with surgery. Your physician may use metal devices to strengthen and stabilize the joint. In some situations, a total hip replacement may be performed. The type of surgical repair will depend upon the type of hip fracture. The physician will determine the best procedure for a person, based on the individual's situation.
The goal of treatment is to provide relief from pain and resume your normal activity level. Hip surgery usually requires an in-hospital stay. While in the hospital, physical therapy exercises are started to regain range of motion and strength in the hip. Physical therapy will continue at home or on admission to a rehabilitation facility.
Serious complications can result from a hip fracture. A patient may have to remain in traction for a specified period of time after surgery. Blood clots can occur in the veins, usually in the legs. If a clot breaks off, it can travel to a blood vessel in the lung. This blockage, called a pulmonary embolism, can be fatal.
Other complications can include:
- muscle atrophy (wasting of muscle tissue)
- post-operative infection
- non-union or improper union of the 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 femoral head, resulting in a loss of blood supply to this area. This is called femoral vascular necrosis or avascular necrosis. This complication may occur depending on the type of fracture and the anatomy of a person's blood supply to the head of the femur bone. This is more common with femoral neck fractures.
Preventing a hip fracture is more desirable than treating one. Preventive measures include taking in enough calcium every day. For women past menopause and not taking estrogen, the National Institutes of Health (NIH) recommends 1,500 milligrams (mg) daily. For those taking estrogen, the recommendation is 1,000 mg. Middle-aged men should take 1,000 mg daily.
Women at menopause should consider having a bone density test. A bone density test is used to measure the bone mineral content and thickness of the bone. This measurement can indicate decreased bone mass, a condition in which 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, produce 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 medications as prescribed by your physician 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 non-skid 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
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