Aging Begins at 30

Statistics Grim For Women's Hip Fractures

Hip fractures in older women are most devastating and costly, while wrist fractures are most common. About 5% of falls result in fractures and 1% cause hip fractures. One of every six white women will have a hip fracture in her lifetime and 90% occur in persons aged 65 and older. Three times as many white women develop hip fractures as non-white women.

There are more than 250,000 hip fractures yearly in the United States. About six in every 1,000 women aged 75 to 79 experience a hip fracture, and 49 per 1,000 women aged 90 and older. Almost all hip fractures require hospitalization and surgical repair.

The U.S. cost is $10 billion yearly. Each episode costs about $18,500 for hospitalization, nursing home care and rehabilitation. Better treatment has led to less confusion, less thromboembolic episodes (leg clots flying off to damage the lungs) and less infection such as pneumonia. Rehabilitation is leading to earlier mobility and weight bearing. Nonetheless about 25% will die within the year and nearly 50% can’t walk independently or regain their prefracture level of independence.

In a 1999 study from a well-defined cohort (those with common statistical characteristics) of 9,704 community women aged 65 and older recruited from population-based listings, there were 203 hip and 321 wrist fractures in four years. Fallers with fractures were compared with a sample of nonfracture fallers.

Who breaks a hip when they fall and why? First women who fall on or near the hip. They are protected if the momentum of the fall is broken by grabbing support or hitting an object before landing. Older fallers are less likely to use a hand to break a fall because of declining strength. Triceps weakness (the large muscle at the back of the upper arm) correlates with hip fracture. They are less likely to have fallen on a hand. A hard landing surface is related to fracture. Falling from greater or less than standing height is not significant, but taller women are at greater risk. Falling to the side or straight down substantially increases the risk of hip fracture. Women with hip fractures did not walk slower than women with wrist fractures and were not any more likely to have their injury caused by falling down stairs. Hip fractures were not associated with fainting or the use of sedatives or alcohol. Women with a stroke, Parkinsonism, or an unsteady gait are at increased risk. Inability to rise from a chair without using one's arms is a predictor of hip fracture.

Women with wrist fractures were more likely to have fallen backward and to have landed on a hand. The nature of the fall determines the site of the break, but decreased bone density is also necessary. With decreased femoral neck bone density there is a seven-fold increase in the risk of hip fracture. The risk of hip fracture increases with aging but the risk of wrist fracture does not. That risk plateaus at age 65.

There is an iceberg of disability but good results come with good discharge planning and early discharge home rather than to the nursing home. Disorientation after surgery, seen in about a quarter, is a bad sign. The social prognosis is best with early return to the patient’s own environment.

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See related Patient Topics Bones, Joints and Muscles, Hip Injuries and Disorders or Injuries and Wounds.

See related Provider Topics Bones, Joints and Muscles or Injuries and Wounds.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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