Hip Fractures Among Older Adults
More than 90% of hip fractures among adults ages 65 and older are caused by falls.¹ These injuries can cause severe health problems and lead to reduced quality of life and premature death.², ³
How big is the problem?
- In 2004, there were more than 320,000 hospital admissions for hip fractures, a 3% increase from the previous year. However, from 1996 to 2004, after adjusting for the increasing age of the U.S. population, the hip fracture rate decreased 25% (from 1,060 per 100,000 population to 850 per 100,000 population).4 Over 90% of hip fractures are caused by falling 5, most often by falling sideways onto the hip.6
- In 1990, researchers estimated that the number of hip fractures would exceed 500,000 by the year 2040.7
What outcomes are linked to hip fractures?
- About one out of five hip fracture patients dies within a year of their injury.8
- Most patients with hip fractures are hospitalized for about one week.9
- Up to one in four adults who lived independently before their hip fracture has to stay in a nursing home for at least a year after their injury.10
- In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion.11
Who is at risk?
- About 76% of all hip fractures occur in women.4
- Hip fracture rates increase exponentially with age among men and women.12 People 85 and older are 10 to 15 times more likely to sustain hip fractures than are people ages 60 to 65.13
- Osteoporosis increases a person’s likelihood of sustaining a hip fracture.14
How can hip fractures be prevented?
Hip fractures can be prevented by preventing falls. Fall prevention strategies include:
- Exercising regularly; To reduce risk of injury from falls, older adults with substantial risk should perform exercises that maintain or improve balance.15 Tai Chi exercises that increase strength and balance are especially good.16
- Having medicines reviewed—both prescription and over-the counter—to reduce side effects and interactions.
- Having yearly eye exams.
- Reducing fall hazards in the home.
The most effective way to prevent fall-related injuries, including hip fractures, is to combine exercise with other fall prevention strategies.17
References
1Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O'Brien LA, et al. Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. New England Journal of Medicine 1991;324(19):1326–31.
2U.S. Bureau of the Census. Population Projections Program, Population Division, Washington, D.C. (2004). [cited 2008 April]. Available from URL: www.census.gov/population/www/projections/popproj.html. *
3Hall SE, Williams JA, Senior JA, Goldswain PR, Criddle RA. Hip fracture outcomes: quality of life and functional status in older adults living in the community. Australian and New Zealand Journal of Medicine 2000;30(3):327–32.
4[NHCS] National Center for Health Statistics, Trends in Health and Aging. http://www.cdc.gov/nchs/agingact.htm. Accessed on [April 22, 2008]. *
5Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ. Epidemiology of osteoporosis and osteoporotic fracturs. Epidemiol Rev 1985;7:178-208.
6Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett HS, Lipsitz LA. Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int 1993;52:192-198.
7Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clinical Orthopedics and Related Research 1990;252:163–6.
8Leibson CL, Toteson ANA, Gabriel SE, Ransom JE, Melton JL III. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. Journal of the American Geriatrics Society 2002;50:1644–50.
9[NCHS] National Center for Health Statistics, Trends in Health and Aging. http://209.217.72.34/aging/ReportFolders/ReportFolders.aspx. Accessed on [April 23, 2008]. *
10Magaziner J, Hawkes W, Hebel JR, Zimerman SI, Fox KM, Dolan M, et al. Recovery from hip fracture in eight areas of function. Journal of Gerontology: Medical Sciences 2000;55A(9):M498–507.
11Centers for Disease Control and Prevention. Incidence and costs to Medicare of fractures among Medicare beneficiaries aged >65 years—United States, July 1991–June 1992. MMWR 1996;45(41):877–83.
12Samelson EJ, Zhang Y, Kiel DP, Hannan MT, Felson DT. Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study. American Journal of Public Health 2002;92(5):858–62.
13Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990;16(3):717–40.
14Greenspan WL, Myers ER, Maitland LA, Kido TH, Krasnow MB, Hayes WC. Trochanteric bone mineral density is associate with type of hip fracture in the elderly. Bone and Mineral 1994;9:1889–94.
15Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C, Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007 Aug 28;116(9):1094-105.
16Li, F, Harmer, P, Mack, K, Sleet, et al. Tai Chi: Moving for Better Balance – Development of a Community-Based Falls Prevention Program J Physical Activity and Health (in press).
17RAND Report: Evidence report and evidence-based recommendations: fall prevention interventions in the Medicare population. Contract no. 500-98-0281. RAND Corporation Southern California Evidence-based Practice Center; 2003.
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