How deadly is a hip fracture for life expectancy?

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.