Things that increase your risk for hip fracture

In older adults, hip fractures are usually caused by a fall. Even a slight fall can sometimes cause a fracture in a weakened hipbone. Children and young adults are more likely to break a hip because of a bike or car accident or a sports injury.

Falls cause more fractures-including hip fractures-as people age because, starting at about age 30, bone begins to be reabsorbed by the body faster than it is replaced. Over time, it naturally gets thinner (less dense), weaker, and breaks more easily. If bones thin a certain amount, you are said to have osteoporosis. Both osteoporosis and hip fracture affect women more often than men because men have higher bone density than women and because of the decrease in the hormone estrogen in women after menopause. Having lower levels of estrogen speeds up bone loss and results in weakened bones. Lower levels of testosterone in men can also speed up bone loss.

Although men are also at risk for hip fracture as they age, women have lower bone density to begin with, more bone loss after middle age, and live longer than men. As a result, more than 75% of all hip fractures occur in women.¹

Some medicines can also cause bone loss. These include antacids that contain aluminum, and corticosteroids used to treat conditions such as asthma and chronic obstructive pulmonary disease (COPD).

Studies have found that daily use of medicines called SSRIs (selective serotonin reuptake inhibitors) may raise the risk of bone fracture in adults over age 50. SSRIs are used for conditions such as depression and anxiety. They are associated with bone loss and also increase the risk of falling.² Talk to your doctor about this risk before taking an SSRI.

One study showed that taking medicines called PPIs (proton pump inhibitors) for a long time, especially in large doses, may raise the risk of hip fracture in adults over age 50. PPIs decrease the amount of acid in the stomach. This reduces heartburn and other symptoms of gastroesophageal reflux disease (GERD). PPIs are also used to give peptic ulcers time to heal.³ Talk to your doctor about this risk before taking a PPI.

Other things that increase the risk for hip fracture include:

• Your family history (heredity). Being thin or tall, or having family members who had fractures later in life increases your risk.
• Race. White and Asian people have a higher risk of osteoporosis; black people have a lower risk. Osteoporosis raises the risk of a fracture if you fall, so the risk of hip fracture is also higher in whites and Asians.
• Poor eating habits. Not getting enough calcium and vitamin D can weaken bones.^{4, 5} Studies show that calcium and vitamin D supplements will not prevent fractures in people who already have risks of fracture such as low body weight or previous fractures.^{6, 7} But getting enough calcium and vitamin D over your lifetime will help you have stronger bones as you age.
• Smoking.
• Not being active. Moderate amounts of weight-bearing exercise, such as walking and dancing, can help keep bones strong.⁸
• Having certain medical problems. Some medical conditions, such as Ménière's disease, can cause problems with balance or dizziness. Other conditions such as arthritis can interfere with your ability to be steady as you walk and move.
• Drug interactions. Sometimes one medicine you are taking changes the action of another medicine, or the drugs act together to create unexpected side effects. These can include dizziness or blurred vision that make falls more likely.

Some things do not themselves raise your risk, but they can indicate that you have a greater risk of fracture. For example, elevated levels of the blood chemical homocysteine suggest an increased risk of fracture if you have osteoporosis. This can be evaluated through a blood test, and treated by getting adequate folic acid. If you have osteoporosis, talk to your health professional about the test for homocysteine.⁹

Research also shows that if you have had a spine fracture or, in men, a Colles fracture of the wrist, you have an increased chance of hip fracture.¹⁰

Citations

1. Cummings SR, Melton LJ III (2002). Epidemiology and outcomes of osteoporotic fractures. Lancet, 359(9319): 1761-1767.

2. Richards JB, et al. (2007). Effect of selective serotonin reuptake inhibitors on the risk of fracture. Archives of Internal Medicine, 167(2): 188-194.

3. Yang YX, et al. (2006). Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 296(24): 2947-2953.

4. National Osteoporosis Foundation. Prevention: Calcium and Vitamin D. Available online: http://www.nof.org/prevention/calcium.htm.

5. National Institutes of Health, Osteoporosis and Related Bone Diseases National Resource Center (2006). Osteoporosis overview. Available online: http://www.niams.nih.gov/bone/hi/overview.htm.

6. Porthouse J, et al. (2005). Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D₃) for prevention of fractures in primary care. BMJ, 330(7498): 1003.

7. Grant AM, et al. (2005). Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (randomised evaluation of calcium or vitamin D, RECORD): A randomised placebo-controlled trial. Lancet, 365(9471): 1621-1628.

8. Feskanich D, et al. (2002). Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA, 288(18): 2300-2306.

9. McLean RR, et al. (2004). Homocysteine as a predictive factor for hip fracture in older persons. New England Journal of Medicine, 350(20): 2042-2049.

10. Haentjens P, et al. (2003). Colles fracture, spine fracture, and subsequent risk of hip fracture in men and women: A meta-analysis. Journal of Bone and Joint Surgery, 85-A(10): 1936-1943.