About 25% of hip-fracture patients 65 years and older die within six months of the fracture… two-thirds die within two years.
Surgery is almost always necessary to repair a hip fracture. Generally, the better your health before a hip fracture, the better your chances for a complete recovery. But for elderly patients, especially those with health problems, a hip fracture can be deadly.
How not to die of a broken hip — plus how to prevent one in the first place…
BASICS TO PREVENT AND HEAL
These measures can help prevent a hip fracture and aid in recovery…
Vitamin D. We’ve seen a significant increase in hip fractures over the last 20 to 30 years. During this same period, people have been increasingly avoiding the sun or using sunscreen to reduce their risk for skin cancer.
What’s the connection? The body synthesizes vitamin D from exposure to the sun’s ultraviolet radiation. People who get little sun often are deficient in vitamin D. Low vitamin D decreases bone and muscle strength, increasing the risk for falls as well as fractures.
What to do: Have your vitamin D measured now and also if you suffer a hip fracture. The level shouldn’t be less than 30 nanograms per milliliter. Many Americans, including younger adults, have a significant vitamin D deficiency. You can supplement with vitamin D — the recommended dose is 400 international units (IU) to 800 IU daily — but I usually advise patients just to get more sun. About 20 to 30 minutes of sun exposure daily without sunscreen — new research shows that noon is best — will provide adequate vitamin D without increasing the risk for skin cancer.
More protein and calcium. Poor nutrition can impair balance, cognitive abilities and bone and muscle strength. It also can delay healing by impairing tissue repair after surgery.
Recommended: Ask your doctor about taking a balanced amino acid (protein) drink one to three times daily after a hip fracture. I also advise patients to eat eight ounces of yogurt a day. Most yogurts supply about 400 mg of calcium. Combined with the calcium in a normal diet, that’s usually enough to promote stronger bones.
MORE HEALING HELP
The following can keep a hip fracture from becoming a death sentence…
Zoledronic acid. It was discovered recently that an intravenous medication called zoledronic acid (Zometa, Reclast), typically used to treat cancer, can aid in recovery from a hip fracture. A 2007 study in The New England Journal of Medicine showed that zoledronic acid reduced hip-fracture mortality by about 28%. Similar to drugs used to treat osteoporosis, it’s a bisphosphonate that inhibits bone breakdown and increases bone strength.
Patients who have fractured one hip have a fivefold increased risk of fracturing the other. This means that their mortality risk is doubled. Zoledronic acid helps to prevent future fractures of the hip as well as the spine.
The drug is given as a five-milligram (mg) infusion once a year. Some patients experience fatigue, muscle aches or fever after the first injection. Subsequent injections are unlikely to cause significant side effects.
Treatment for depression. Depression is extremely common after a hip fracture, partly because patients often feel helpless and dependent.
Why it matters: Patients who are depressed are less likely to exercise and follow through with a rehabilitation program. They also are more likely to get a subsequent fracture because depression increases the body’s production of cortisol, a substance that depletes bone calcium.
Most patients with depression do best with medication, alone or in combination with talk therapy.
Caution: Drugs in the SSRI class of antidepressants, such as paroxetine (Paxil), can impair alertness and coordination and increase the risk for falls. These drugs also pull calcium from the bones. Some of the older antidepressants, such as nortriptyline (Pamelor, Aventyl), are a better choice for hip-fracture patients because they are less likely to impair alertness and balance.
Pain relief. Postsurgical pain is normal — chronic pain that lasts months or years after hip surgery is unacceptable. Chronic pain interferes with exercise and rehabilitation. It also is a leading cause of depression. You should never have chronic pain after hip surgery. Some patients do fine with over-the-counter pain relievers, such as ibuprofen, but others need stronger painkillers. If you’re hurting, tell your doctor.
Helpful: The Wong-Baker FACES Pain Rating Scale. Patients look at illustrations of facial expressions (which are accompanied by a number) and choose the one that reflects their pain. During rehabilitation, no one should experience pain greater than a three or four. During daily life, pain should be rated no higher than a one or two.
Prevention of clots and pneumonia. Hospital patients have a high risk of developing deep vein thrombosis, a life-threatening condition in which blood clots in the legs travel to the lungs and cause a pulmonary embolism. They also have a higher risk for pneumonia, partly because being sedentary can allow mucus to collect in the lungs, providing a breeding ground for bacteria.
What to do: In the hospital, move as much as you can, even if it is nothing more than regularly flexing your legs or sitting up in bed.
Patients who have had hip surgery are routinely referred to a physical or occupational therapist. After that, they should continue to be active — ideally, by walking or doing other forms of exercise for 20 to 30 minutes most days.