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Falling is very common among older persons. All too often, falling can cause serious injuries such as broken bones and sometimes, hospital and/or nursing home admission. People 60 years and older tend to fall more than younger people. They also have more severe injuries and complications from those injuries. It is known that the risk of death is increased for people who have suffered a broken (fractured) hip. Research studies have shown that the risk of death in the year following a hip fracture ranges from 20% to 25%, depending on race, sex, age, and additional medical problems.

New Research in the Journal of the American Geriatrics Society

Recently, researchers analyzed data from the Cardiovascular Health Study, a very thorough study that tracked over 5800 patients for about 15 years. That study looked at heart problems, high blood pressure, diabetes, and other risk factors that can lead to higher death rates in community-dwelling men and women older than 64 years. Data from this study gave the researchers extensive background information about the participants' health and ability to take care of themselves, which helped to predict the risk of death following hip fracture.

Study participants consisted of white and African-American residents from 4 U.S. communities who were eligible for Medicare. The researchers "matched" 3 people who did not have a hip fracture for each person who did have a hip fracture by their age, sex, race and how long they had been in the study. Finally, the researchers used known criteria to identify which patients had diabetes, depression, poor kidney function, decreased mental ability, and if they were considered frail. They also kept track of other risk factors which increase the risk of death, such as smoking, blood pressure, alcohol use, and heart disease.

There were 379 hip fractures (282 among women). Hip fractures were more common among people with lower body weight and people who had lost more than 10% of their body weight after age 50. Hip fractures were also more common among people who had lower mental ability scores, self-reported poorer health status, frailty, worse lung function, and cardiovascular disease.

When compared to their "matched" study participants who did not suffer hip fracture, the death rate was higher for the hip fracture patients, as expected. Death associated with hip fracture was highest in the first month following fracture for both men and women. The death rate decreased greatly over the next 6 months after fracture. The higher death rate following a hip fracture was only partially explained by poorer pre-fracture health. Men had a much higher risk of death during the first 6 months after the fracture, but then improved to having no more risk than someone who had not had a fracture. Women did not have as high a risk of death, but remained at higher risk for as long as 4 years.

What Should I Do?

It is important for older people, their families, and caregivers to talk to their health care providers about their own risk factors for having a hip fracture, such as osteoporosis (thin and brittle bones) and possibly unexplained weight loss after age 50. It is also important to talk to your health care provider about risks for other problems such as falling that can lead to a hip fracture, and what can be done to reduce the risks.

For more information about hip fracture and preventing fractures, visit the Falls and Osteoporosis chapters on Aging in the Know.

The summary above is from the full report titled, "Adjusted Mortality After Hip Fracture: From the Cardiovascular Health Study." It is in the December 2006 issue of the Journal of the America Geriatrics Society (Volume 54, Issue 12). The report is authored by John Robbins, MD, MHS, Mary L. Biggs, MPH, and Jane Cauley, DrPH.