Preventing Hip Fractures Is More About Preventing Falls

Hip leg pelvis xrayIf you’re over the age of 65 or have a family member who is, you’ve probably heard about hip fractures. These breaks are far more common in the senior population and are concerning because they often signal a rapid worsening of health. The assumption has long been that the weakening of bones with age, called osteoporosis, was the main culprit behind why older adults were so likely to get these fractures. But new research out this week has found that lowering your risk of falls may actually be the main player in preventing hip fractures.

What is the hip, and why are fractures so concerning?

The hip is a joint between your pelvis (the bone that sits at the bottom of the spine and across your waist) and the femur (the long bone in your thigh). The hip joint is a ball-and-socket joint, meaning the top of the femur is round and fits into a circular dent in the side of the pelvis. The two are held together by a number of ligaments that surround the joint and hold it tight. The spot on your thigh you normally think of as your “hip” is actually a bony point that sticks off of the femur and serves as a place for muscles to attach. The bones you think of as your “waist” are the top of the pelvis.

There are a few places the bones in this joint can fracture, but the most common place is just below the top of the femur. This type of a fracture is dangerous for two main reasons. First, the blood supply to the top of the femur mostly comes through the part that often fractures. When the bone breaks, blood supply can get cut off and the top can die or have trouble healing. Second, the break makes movement very painful. Those who fracture their hip often stop moving or walking as much and slowly become weak and unable to care for themselves. This can lead to a steady decline in health from which many don’t return. Up to one in three older adults who fracture their hip die within a year.

What is osteoporosis, and why was it thought to be involved?

Your bones start out as soft and flexible cartilage when you’re a baby, but the body slowly replaces that cartilage with hard bone. It continually layers, thickens, and strengthens your bones until your mid-thirties. From there, bone density lowers as you age, although weight-bearing exercise can slow it down. When bone density drops below a certain point, you’re diagnosed with osteoporosis.

Weaker bones tend to break more easily, which is why many doctors thought that men and women with osteoporosis would be more likely to end up with hip fractures. Some studies had also shown that taking medications to strengthen bones might lower fracture risk so lots of effort was put into treating adults with low bone density to try and slow bone loss and hopefully prevent hip fractures.

What did this study find?

These researchers wanted to see whether these treatments actually lowered a person’s likelihood of getting a hip fracture. They surveyed all of the research that had been published looking at how osteoporosis medications affected hip fractures. They found that most studies were done in people younger than 75 in spite of the fact that three out of four hip fractures occur in people over 80. Almost all studies focused on women even though more than a third of hip fractures happen in men. When they reanalyzed the data in a more balanced way for age groups most at risk, they found little evidence to show that those most at risk for fractures actually benefited in any way from taking these medications. Unfortunately, these medications are not without side effects. Many cause stomach troubles and some can lead to certain heart and bone problems. On top of that, research has shown than people diagnosed with osteoporosis tend to become more afraid of falling and limit how much they move as a result, which can actually increase their risk for a hip fracture.

What can I do for myself or my loved ones?

The researchers found that other interventions focused on increasing strength and lowering the risk of falling are far more effective at preventing hip fractures. That’s because it’s the falls, rather than low bone density, that actually cause the breaks. You can lower fall risk by:

  • Exercising. Weight-bearing exercise and weight lifting even with light weights can dramatically slow bone loss. It also has the benefit of strengthening muscles that can help improve balance and lower the risk that a person will fall.
  • Quitting smoking. Smoking at any age increases bone loss and the risk for osteoporosis. If you quit, bone loss slows and you lower your risk for fractures if you fall.
  • Eating well. A varied diet high in fruits, vegetables, whole grains, and lean sources of protein provides essential nutrients for bones to rebuild themselves, lowering fracture risk if you fall.
  • Taking care of your vision. Falls are more common if you can’t see well. Make sure you or your loved one wears glasses if you need them and that you have the right prescription.
  • Removing potential dangers. Many falls happen when a carpet edge, step, cord or other unexpected obstacle gets in the way of where a person is walking. Check your home and make sure walkways are clear of things that could trip a person and mark any steps or ramps with colored tape.