How deadly is a hip fracture for life expectancy?
A hip fracture strongly increases the risk of dying for many years, especially in older men and people with other illnesses. Operating quickly (within 36 hours) appears to limit the damage.
A hip fracture is considerably more dangerous than most people realise. In the first three months after the fracture, the risk of dying is five to eight times higher than in peers without a fracture. After that first year the risk decreases somewhat, but it remains elevated for many years afterwards: it never fully returns to the level seen in people without a fracture.
How long the elevated mortality persists is striking. In the first year after the fracture, the chance of dying is almost three times as high as in peers. After that, even at eight years, the risk is still nearly twice as high. Men fare worse on average than women: in men who sustain the fracture at age 80, the cumulative excess mortality after ten years is 20%. In women it is 22%, but the annual mortality risk is higher in men at every point in time.
Not everyone faces the same risk. Patients over 90, men, people with multiple chronic diseases simultaneously, and people with anaemia at admission face a particularly large risk of not leaving the hospital. Dementia is an especially heavy factor: of patients with dementia who undergo hip fracture surgery, nearly four in ten die within a year.
The timing of the operation appears to matter. One study of 806 patients shows that operating within 36 hours significantly reduces the chance of dying at 30 days and at one year. Waiting until 48 hours was not enough to see a clear effect on short-term mortality. This is not yet definitive evidence, as it is a single retrospective study and sicker patients are more often operated on later, which can skew the results. It does, however, provide a concrete reference point for hospital protocols.
Based on two large meta-analyses (including a cohort of 122,808 participants with an average follow-up of 12.6 years), a meta-analysis specifically on dementia and hip fracture, and two smaller cohort studies on surgical timing and in-hospital mortality.
Why do older people break their hip so easily?
Older bones are both thinner and more brittle, and reduced muscle strength makes falling more likely. This is a well-understood combination; the good news is that through exercise, adequate calcium and vitamin D, and avoiding smoking and prolonged corticosteroid use, you can work on several levers at once.
Does diabetes increase the risk of bone fractures?
Both type 1 and type 2 diabetes clearly and demonstrably increase the risk of bone fractures. If you have diabetes, discuss with your doctor whether your bone health is being properly monitored, as the standard risk score underestimates this risk.
Can eating disorders such as anorexia cause lasting bone damage?
Anorexia can cause lasting bone damage, especially when the illness begins during puberty. Early recovery is crucial; speak with your doctor about this if you or someone you know is affected.
Does too little protein increase your risk of bone fractures as you age?
Yes, too little protein increases your risk of bone fractures in older age. This works through weaker bones as well as through poorer muscle condition. Aim for at least 1.0 to 1.2 grams of protein per kilogram of body weight per day, preferably together with adequate calcium and vitamin D.
How much impact does smoking have on your bone density?
Smoking substantially increases the risk of bone loss and hip fractures; quitting helps, but it takes at least ten years before your fracture risk decreases noticeably.
Does drinking a lot of coffee increase the risk of bone fractures?
For most people, coffee does not appear to be a proven cause of bone fractures, but for women who drink a lot of coffee some caution is reasonable; in that case, make sure to get enough calcium and vitamin D in your diet.