Life not the same after hip fracture

Dear Doctors: Our grandmother, who is 91, fell and broke her left hip. She wound up needing a partial hip replacement. I’ve read that hip fractures are dangerous for older adults. Can you explain why?

Dear Reader: A hip fracture is a serious and yet common outcome when an older adult has a fall. It occurs due to the progressive decrease in bone mass that often affects women and men as they age. Another risk for hip fracture is osteoporosis, a skeletal disease marked by a loss of bone density, which leaves bones porous, thin and brittle.

Because of the hormonal changes that occur during menopause, women are at increased risk of developing osteoporosis.

Unfortunately, it’s true that a hip fracture in older adults can contribute to poor outcomes, including an increased risk of death. A number of factors play a role. These include the age of the patient, their sex and the health problems the person was living with before the fracture, such as cardiovascular, pulmonary or neurological issues; diabetes; declining cognition or frailty.

Most hip fractures in older adults require surgery to restore mobility and to manage pain. This puts patients at risk for a range of post-surgical complications, including infection, blood clots in the lungs or legs, bedsores, urinary tract infection and pneumonia. Recovery for adults who are older or frail can take months. This often leads to further loss of muscle mass, which then increases the risk of a subsequent fall. Due to the length of recovery, a hip fracture also often leads to a decrease in independence.

Unfortunately, many older adults won’t return to their same level of activity and independence following a hip fracture. Your family should be prepared to make arrangements to get your grandmother the future help she will need. — Eve Glazier, M.D., MBA; and Elizabeth Ko, M.D.