I always hear about older folks fracturing their hips. Is this because of osteoporosis or because of the frequency of falls? How are broken hips repaired?

Almost 350,000 people are hospitalized for hip fractures in the United States every year, and most of them are women over the age of 65. White women are hospitalized for hip fracture at a rate five times that of Black women. However, Black women have more disability and death related to their fractures than White women. If you are a Black woman, you are 2 to 3 times more likely to die from a hip fracture than your White counterpart.

Because 95% of hip fractures occur as a result of falls, it is important to look at ways of preventing them (see Question 79). Breaking a hip may be the first sign that someone has osteoporosis. If you have already lost 30% to 40% of the bone in your hip, then bone loss may be visible on the x-ray. If your hip fracture occurs from a low level of trauma (like falling out of bed), you may be diagnosed with osteoporosis without having a bone density test done. If not, then you may not be officially diagnosed with osteoporosis until a BMD test confirms it, although it's unlikely that BMD testing would be done while you're in the hospital. As part of your hip fracture management, you may be placed on a medication to treat osteoporosis (see Question 74).

If you fall, the signs and symptoms that you may have a hip fracture include severe pain in the hip or groin, inability to bear weight, a shortened leg on the side with the potential fracture, and bruising or swelling in the groin. Sometimes the position of your leg (turning inward or outward) after falling or trauma can be a clue for your clinician to the possibility of hip fracture. Figure 12 shows the normal pelvis, hips, and usual locations of hip fractures.

Locations of typical hip fractures.

Figure 12 Locations of typical hip fractures.

In people who are likely to have severe complications related to surgery, orthopedic surgeons use a traction (tension) system to help the hip fracture heal. But the extended immobility associated with this treatment has its own complications. Being immobile for a long time can lead to blood clots, urinary incontinence, loss of muscle conditioning, pneumonia, pressure sores (bedsores), depression, social isolation, and greater bone loss. Unfortunately, once you fracture your hip or any other bone, you are at greater risk of fracturing a bone again.

The surgical treatment of your hip fracture will depend on the sites of the fracture. If you fracture the femoral neck (Figure 12), you may have a screw inserted, a partial hip replacement, or a total hip replacement. The total hip replacement involves replacing both the upper part of your femur bone, the "ball" of the bone, and the socket into which the ball fits. If you break the intertrochanteric part of the bone (Figure 12), you are likely to have a special compression screw inserted with a metal plate to keep the edges of the bone together.

The recovery time in the hospital after surgery is usually about 1 week. If you don't have someone to assist you at home, a nursing home or rehabilitation center stay may be required so that you can also get the necessary physical therapy. Hip fractures can cause considerable expense and disability, not to mention social isolation, depression, and even death. As you age, you should make every effort to avoid falls and to strengthen your bones so that if you do fall, you will be less likely to break a bone again.

The physical recovery from hip fractures may take less time than the emotional aftereffects of having a fracture. Fractures can interfere significantly with your independence. The realization that you can no longer do for yourself what you've always done can be devastating. In a study of previously independent adults following hip fractures, two-thirds of them were unable to get on and off the toilet without help 12 months after the fracture, and 83% could not bathe or shower by themselves. No wonder depression can set in! A vicious cycle of fear, isolation, dependence, and depression can result. In the event of a hip fracture in yourself or in a loved one, you should pay attention to the very real possibility of depression.

• Get the medical and nursing care that you need. If the discharge planners at the hospital where you have been cared for do not provide you with home care, have a relative arrange it for you. Many insurance plans will provide for visiting nurses and health aides in place of paying for extended hospitalizations. Medicare will also pay, at least partially, for these types of services. In many cases, you may need to go from the hospital to a rehabilitation hospital. If you don't seem to be making progress, ask for a reevaluation.

• Allow family and friends to help you. It may seem rather ironic that in order to keep your independence in the long term, you may need to ask for some help in the short term. Let people help you—giving others the opportunity to help you may also help allay their sense of helplessness about your situation and make them feel needed.

• Family and friends may not know about your hip fracture. Contact friends and family to let them know you may need some assistance in the days and weeks following surgery. Sometimes even if they know, they won't contact you for fear of disturbing you. Let them know about your surgery and that you would appreciate their support. If they ask what you need, be specific, even if it's only to check on you by phone once a week. If people bring lots of food, ask someone to help you organize smaller meals.

• If you are accustomed to a particular daily activity (e.g., walking with a friend) or weekly activity (such as playing cards), try to stay on your friends' radar screens. Have the friend come to your house and exercise instead of walking. Invite the card-playing friends over for a shorter-than-usual gathering. The main idea is to stay on the calendar and keep in touch.

• Fear of falling or getting another fracture can be intimidating. Be cautious, but don't isolate yourself from going out once you are able. If you're used to driving yourself to church, ask a fellow church member for a ride.

• Just because you are less independent, this doesn't mean you can't use your brain. Continue to stay mentally active. Keep up with the news. Read. Do crossword puzzles. Talk to friends by phone.

• Nip the signs of depression in the bud (see Question 82). Contact your clinician or a mental health professional for help.

Marjory's comment:

I really can understand why people with depression get osteoporosis or why people with osteoporosis get depressed. It's so sad and depressing when you stay home and don't get out and get moving. Exercise doesn't just help you feel better physically and help you sleep better—exercise makes you feel so much better about yourself. It's good for me to get out of the house. Taking classes is such a good thing to do socially. I enjoy being with other people. Occasionally someone will join our water exercise class and might be withdrawn and reluctant to be therefore whatever reason. After a few classes when we call each other by name, they really start to enjoy themselves. When I try to do the exercises by myself, I find I don't stick with finishing the exercises, work as hard, or enjoy it nearly as much as I do when I take a class with others. In our area, if you can't drive yourself to exercise classes, there is a bus for seniors that can take you to "health-related" activities, like medical appointments and the pharmacy. I can't think of anything more "health-related" than exercise! Going to a scheduled exercise class gives me someplace specific to go. When I get home, I tell my husband about the people I saw, maybe a joke I heard, and it really gives us something to talk about every day. I have also found that exercising helps me sexually. Sex is so much more comfortable when I'm feeling fit and good about myself. My feeling is that we're all going to have aches and pains, and sometimes it feels easier to stay home and not do anything, but you know what? You're going to have those aches and pains no matter what, so you may as well live well, get out with others, and have a good time.

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