Hip fractures common among the elderly
DEAR DOCTOR: I know of several older women who have died within a year after a hip fracture. Is this due to a cause and effect of a bone fracture or something else entirely?
DEAR READER: Hip fractures are common as we get older. The lifetime risk of a hip fracture in a woman is 17.5 percent; for men, it’s 6 percent. Women have greater rates of osteoporosis than men and thus the greater risk of fractures.
The most common reason for an older person to get a fracture is a fall. Such a fall doesn’t usually occur from hiking mountainous terrain; 90 percent of hip fractures in the elderly occur in the home because of a fall from a standing position. The loss of balance that precipitates a fall occurs because of weakness in hip girdle muscles and/ or generalized weakness due to illness, medication and/or a prior stroke.
The majority of displaced hip fractures will require surgery to repair. The surgery can be either a total hip replacement or a surgery to bring the misaligned pieces of bone together using metal screws, rods and plates. Surgeries are fraught with possible complications, leading to a greater risk of debility and even death.
Waiting too long to have a surgery for a hip
fracture also can lead to prolonged bed rest, resulting in an increased chance of blood clots in the legs, bed sores, urinary tract infections, pneumonia and, again, death.
Another problem, before and after surgery for a hip fracture, is that elderly patients are especially likely to become delirious. One study found that 61 percent of elderly patients with a hip fracture had an acute state of confusion. This confusion leads to greater agitation, an inability to eat and limited ability to recover from a hip fracture. In addition, confusion can lead to medications to sedate an agitated patient, further delaying recovery.
For some, recovery from a hip fracture can take months. Long hospital and rehabilitation facility stays lead to an even greater risk of complications.
So prevention is crucial. Regular exercise, use of calcium and maintaining good vitamin D levels are absolutely necessary.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.
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