Hip fractures

Hip Fractures Among Older Adults

More than 95% of hip fractures among adults ages 65 and older are caused by falls (Grisso et al. 1991). These injuries can cause severe health problems and lead to reduced quality of life and premature death (Wolinsky et al. 1997; Hall et al. 2000).

How big is the problem?

In 2003, there were more than 309,500 hospital admissions for hip fractures (NCHS 2006).
From 1993 to 2003, the number of hip fracture hospitalizations increased 19%, from 261,000 to 309,500 (NCHS 2006).
However, after adjusting for the increasing age of the U.S. population (U.S. Census Bureau 2006), the hip fracture rate decreased 14%, from 901 per 100,000 population in 1993 to 776 per 100,000 population in 2003 (NCHS 2006).
In 1990, researchers estimated that the number of hip fractures would exceed 500,000 by the year 2040 (Cummings et al. 1990).

What outcomes are linked to hip fractures?

As many as 20% of hip fracture patients die within a year of their injury (Leibson et al. 2002).
Most patients with hip fractures are hospitalized for about one week (Popovic 2001).
Up to 25% of adults who lived independently before their hip fracture have to stay in a nursing home for at least a year after their injury (Magaziner et al. 2000).
In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion (CDC 1996).

Who is at risk?

Women sustain about 80% of all hip fractures (Stevens et al. 2000).
In 2003, 72% of hip fracture hospitalizations were among women (NCHS 2006).
Among both sexes, hip fracture rates increase exponentially with age (Samelson et al. 2002). People 85 and older are 10 to 15 times more likely to sustain hip fractures than are people ages 60 to 65 (Scott et al. 1990).
People with osteoporosis are more likely to sustain a hip fracture than those without this condition (Greenspan et al. 1994).

How can hip fractures be prevented?

Hip fractures can be prevented by preventing falls. Fall prevention strategies include:

Exercising regularly; exercise programs like Tai Chi that increase strength and balance are especially good.
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 these strategies (RAND 2003).

References

Centers 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.

Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clinical Orthopaedics and Related Research 1990;252:163-6.

Greenspan 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.

Grisso 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.

Hall 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.

Leibson 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.

Magaziner 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.

National Center for Health Statistics, Centers for Disease Control and Prevention. National Nursing Home Survey (NNHS) Public-Use Data Files. [cited 2006 Oct 20]. Available from URL: http://www.cdc.gov/nchs/products/elec_prods/subject/nnhs.htm.

Popovic JR. 1999 National Hospital Discharge Survey: annual summary with detailed diagnosis and procedure data. National Center for Health Statistics. Vital Health Statistics 2001;13(151):154.

RAND 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.

Samelson 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.

Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990;16(3):717-40.

Stevens JA, Olson S. Reducing falls and resulting hip fractures among older women. In: CDC Recommendations Regarding Selected Conditions Affecting Women’s Health. MMWR 2000;49(RR-2):3-12.

U.S. Bureau of the Census. Population Projections Program, Population Division, Washington, D.C. (2003). [cited 2006 Aug]. Available from URL: www.census.gov/population/www/projections/popproj.html.

Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. American Journal of Public Health 1997;87(3):398-403.

Content Source:
Page last modified: August 26, 2006