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A broken bone may not sound serious, but if you are an older man or woman, a hip fracture can be the start of many severe health problems. How dangerous is a broken hip in an older person, and what is the mortality rate after a hip fracture?
Answer:
A broken hip, also known as a hip fracture, can lead to serious disability, even death.
The price of a fall: Falls have the dubious honor of being the top cause of injury and injury-related deaths in people older than 65. A fall can result in a major decline in independence; a person who suffers a hip fracture may no longer be able to live independently in the community, and might have to move to residential care for greater assistance in day to day activities.
Mortality rate after a broken hip: A few different research studies have investigated the mortality rate after a hip fracture. For example, a 2011 paper published in the Journal of the American Medical Association (Internal Medicine) investigated a total of 5,580 older women over a period of almost 20 years. The women were recruited from four regions in the United States between 1986-88, for the Study of Osteoporotic Fractures (SOF).
The mortality rate was double among the women who'd suffered a broken hip in the first year after injury. In other words, during the 12-month period after breaking their hip, those women had twice the risk of death, when compared with women of a similar age without a hip fracture. More than half the deaths occurred within the first three months after a break.
Previous studies, such as a meta-analysis published in 2010 in the Annals of Internal Medicine, have shown an even higher rate of short-term mortality after a hip fracture. In this review of studies published between 1957 and 2009 (involving a total of 578,436 women and 154,276 men over the age of 50), researchers from Belgium and the United States found the risk of death in both men and women — in the three months after a hip fracture — to be between five and eight times higher. While the greater risk of death diminished two years after the fracture, mortality rates remained higher than those for older people who'd never broken a hip, even after 10 years of follow-up. Excess mortality was higher among men, than women, in this review.
Causes of death: What do patients die of, after a hip fracture? The 2011 study found that when compared with controls of similar ages, a greater number of women died of pneumonia, and cognitive disorders. In the Annals of Internal Medicine analysis, a number of causes of short-term mortality were suggested, including problems that can occur after surgery (such as pulmonary embolism, infection, and heart failure). In addition, health problems that could have led to the fall in the first place — such as dementia, chronic obstructive pulmonary disease (COPD), and cardiovascular disease — are also cited as contributors to the increased mortality. The researchers note that generally speaking, people who break a hip are more functionally impaired before the fracture, than those who do not suffer a fracture.
While age is a major risk factor for falls, a person who is healthy and fit may be considered to have a lower chronological age, leaving them less susceptible to falls and fractures.
Incidence and health costs of hip fractures in North America: Hip fractures represent a major health cost in terms of treating the victims. In the United States, about 300,000 people suffer a hip fracture each year. In Canada, approximately 27,000 older people break a hip each year, with the cost of treatment estimated at more than $1B.
Research continues into how best to prevent falls that cause fractures, including better design of assistive devices such as walkers, softer flooring materials in nursing homes, and targeted occupational and physical therapy to boost balance and strength.
Sources:
Erin S. LeBlanc, Teresa A. Hillier, Kathryn L. Pedula, Joanne H. Rizzo, Peggy M. Cawthon, Howard A. Fink, Jane A. Cauley, Douglas C. Bauer, Dennis M. Black, Steven R. Cummings, Warren S. Browner. "Hip Fracture and Increased Short-term but Not Long-term Mortality in Healthy Older Women." Arch Intern Med. 2011;171(20):1831-1837.
http://archinte.jamanetwork.com/article.aspx?articleid=1106014
Falls and Fractures. US NIH National Institute on Aging Public Information Sheet. Accessed March 6, 2013.
http://www.nia.nih.gov/health/publication/falls-and-fractures
Haentjens P, Magaziner J, Colón-Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380-390
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