Hip fractures significantly contribute to morbidity and mortality, particularly in the elderly population. It is estimated that as high as 36 percent of adults who fracture their hip will die within one year of the fracture.
It may be hard to believe, but the primary cause is a minor fall when certain risk factors are present.
Osteoporosis is the leading risk factor, with age and gender being secondary. The rate of hip fractures doubles each decade after age 50, with individuals over 80 accounting for half of all annual incidents. Women are more vulnerable than men because of their greater disposition to osteoporosis.
Besides osteoporosis, other modifiable risk factors include impaired vision, physical inactivity, low body weight, neurological impairment (causing loss of balance), cigarette smoking, excessive caffeine intake, alcohol abuse and medications that deplete bone mass (especially prolonged use of corticosteroids). Recent studies found that cardiovascular disease is also a risk factor for hip fracture.
To prevent hip fractures, focus on the modifiable risk factors. As the term “modifiable” indicates, these are the risk factors that can be addressed proactively to reduce the risk of hip fractures. Eliminating alcohol, excessive caffeine use and quitting cigarettes will preserve your bone density. Since osteoporosis is treatable if detected, a simple bone density test can determine if you are at risk. Postmenopausal, white females are in the highest risk demographic.
Women in this demographic should discuss their concerns with their primary treating physician, especially if they are on medications that lead to loss of bone mass. Weight-bearing exercise, dietary calcium and vitamin D are generally helpful in improving bone mass; however, the underlying cause of the bone loss must be determined for successful intervention.
Since minor falls are the primary cause, it’s important to safety-proof your house by increasing lighting, removing throw rugs and clutter. It is also advisable to strengthen the musculature of the core, pelvis and legs and improve one’s balance. It is estimated that we lose 5 percent of our muscle mass every 10 years after the age of 35. My clinical experience tells me this rate of loss is likely even higher in the geriatric population.
Walking and other strengthening exercises have significantly correlated to reduced risk of hip fractures. If you feel you are having difficulty with balance or activities of daily living such as climbing stairs or getting out of a chair, these may be signs of significant loss of muscle mass.
Medicare considers loss of balance and abnormal or difficult gait, amongst other similar impairments, as valid diagnoses for physical therapy. It is more cost-effective to proactively improve your balance, strengthen and increase cardiovascular endurance than to pay for hip surgery.
Discuss a prescription for physical therapy with your primary treating physician. The value of physical therapy in helping you regain strength and balance in a safe clinical environment is invaluable for everybody concerned: certainly for the individual with the risk, the taxpayer by way of reduced dependence on surgery and the intangible benefit to the families of the patient.
Hip fractures are a reality of life that can be avoided. If you think you are risk, take action today. Bear in mind, there may be multiple factors, so a multipronged approach, including addressing any underlying causes of osteoporosis, elimination of risky behaviors in combination with a clinical approach to strengthening, will give you the best chance to avoid a hip fracture.
— Sevak Khodabakhshian is a doctor of chiropractic with Thousand Oaks-based Omega Rehab & Sport, where a team of physical therapists, chiropractors and athletic trainers applies an active-care approach to healthcare. He can be reached for comments, questions or suggestions by e-mail, at Sevakk@omega-rehab.com.