Preventing hip fractures in the elderly

Hip fractures present a huge challenge to older people and healthcare systems. That is why fracture prevention strategies are so important in their overall care.

In this article, Professor Xavier Griffin, a top consultant trauma and orthopaedic surgeon based in London, Oxford and Banbury, explains the measures that should be employed to prevent hip fractures in older people.

Why is preventing hip fractures so important?

Hip fractures are a significant issue for older people and their recovery is often complicated. It presents a huge challenge to both the healthcare system and their families, requiring a coordinated multidisciplinary approach that extends far beyond the operating room.

Unfortunately, older people can develop life-threatening complications both during and after hip surgery, such as blood clots, infections and irregular heart rhythms. So, with the burden of these health problems and now the additional risk of contracting COVID-19, the real challenge lies in prevention. It is therefore important to employ effective prevention strategies to improve the quality of life in this group of patients.

How can fractures be prevented?

Two main fracture prevention strategies are employed: Reducing the risk of falls and improving a person’s bone health.

• Reducing the risk of falls

Older people should be assessed to identify any medical causes that might result in falling. Conditions include postural hypotension, syncope and irregular heart rhythms. Basic investigations should be coupled with a clinical assessment, such as lying and standing blood pressure and a 12-lead ECG, and a regular review of current medications.
 Mechanical causes for falling such as poor mobility, balance and impaired vision should also be assessed. A home assessment should also be done with modifications made if needed.

• Improving bone health

If a patient has low bone density or osteoporosis, it can significantly increase their risk of fracture. Bone density tests are therefore recommended for older people at risk of fractures.

Exercises can also maintain muscle strength and reduce the risk of slipping and tripping up. Likewise, a diet that provides enough calcium and vitamin D is equally important.

How can you fall-proof your home?

Most falls in older people occur in their own homes. There are, however, easy changes that can be made to significantly reduce your risk of tripping up and slipping over objects:

• install rails and grab bars, suitable bathroom equipment and a stairlift
• remove loose rugs
• replace rugs with non-slip mats
• improve the overall lighting
• keep the floors and staircases clutter-free
• wear comfortable and well-fitted shoes

What type of exercises are effective?

Moderate exercise is important to slow bone loss, maintain muscle strength and improve balance and co-ordination. Balance training has been shown to reduce the risk of hip fractures. Other good exercises include:

• swimming
• yoga
• tai chi
• working with resistance bands
• weight lifting

Which tests and medications can be offered?

To help ensure that your bone health is maintained, a bone health profile can be obtained through routine blood tests to identify calcium or vitamin D deficiency. People aged over 50 years and men should consider if they need to supplement their calcium and/or vitamin D intake. This can be achieved from a combination of a healthy diet and supplements.

Furthermore, osteoporotic fractures can be prevented with medication such as oral bisphosphonates, which can slow bone loss and reduce fracture risk. This should be considered for postmenopausal women over 75 years of age and in younger people who have been diagnosed with the condition.

Despite the global scale of the problem and the huge impact of sustaining a hip fracture on a patients quality of life, our understanding of this challenging injury is still very much evolving.

If you are worried about your bone health and would like to find out more about your bone health and fracture risk, you can make an appointment with Professor Xavier Griffin through his Top Doctors profile.