Hip Fracture
What is a hip fracture?
A hip fracture is a break in the femur of the hip joint. 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.
What are the different types of hip fracture?
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:

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.
Who is affected by a hip fracture?
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 are affected two to three times more often than non-Caucasians
primarily because of a higher rate of osteoporosis. Osteoporosis 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 89 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 270,000 occurrences each year. In
2003, there were about 345,000 hospitalizations for hip fractures. It is estimated that the number could exceed 500,000
by the year 2040.
Why is a hip fracture so serious?
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.
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 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.
Risk factors for hip fracture:
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/or caffeine consumption
 lack of physical activity
 low body weight
 tall stature
 vision problems
 dementia
 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
What are the symptoms of a hip fracture?
 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.
How is a hip fracture diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for hip fracture may include
the following:
 x-ray
 magnetic resonance imaging (MRI)
 computed tomography scan (Also called a CT or CAT scan) Treatment for a hip fracture:
Specific treatment for hip fracture depends upon
 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
Complications of hip fracture:
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:
 pneumonia
 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.
Prevention of hip fracture:
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