A hip fracture is a break in the upper part of the thigh bone near the hip joint, representing a serious injury that requires immediate medical attention and typically surgery to repair. Most common in older adults whose bones have weakened with age, this injury can significantly affect a person’s ability to walk and live independently, making prompt treatment and careful recovery essential for the best possible outcome.

Understanding Hip Fractures and Their Impact

A hip fracture is not simply a broken bone that will heal on its own with rest. It is a medical emergency that requires hospital treatment right away. The hip is a ball-and-socket joint where the rounded top of the femur (the thigh bone, which is the longest and strongest bone in your body) fits into a cup-shaped socket in the pelvis bone called the acetabulum. When a hip fracture occurs, it means the upper portion of this femur has broken, typically in one of several specific locations near the hip joint.^[1]

The hip joint plays a crucial role in supporting your body’s weight and enabling you to walk, stand, and move about freely. When this area is damaged, even the simplest daily activities like getting out of bed, using the bathroom, or sitting in a chair can become impossible without assistance. This is why hip fractures are considered life-changing injuries, especially for older adults who may already face challenges with mobility and independence.^[4]

Healthcare providers classify hip fractures based on exactly where the break occurs along the upper femur. The most common types are femoral neck fractures, which happen in the narrow section of bone just below the ball-shaped head of the femur, and intertrochanteric fractures, which occur slightly lower down, in the area marked by two bony bumps where muscles attach. Less commonly, fractures can occur in the femoral head itself (the ball portion) or in the subtrochanteric area below the bony bumps. Understanding the location of a fracture helps doctors determine the best way to repair it.^[1][2]

How Common Are Hip Fractures?

Hip fractures are remarkably common, particularly among older adults. Each year, more than 300,000 people in the United States experience a hip fracture, with most of these injuries occurring in adults aged 65 and older.^[1] The average age of someone who breaks their hip is around 80 years old.^[3] Looking at the broader picture, the yearly occurrence per 100,000 people in the United States ranges from 197 to 201 for men and 511 to 553 for women, showing that women experience hip fractures much more frequently than men.^[3]

Women account for approximately 80% of all hip fractures.^[5][15] This striking gender difference is largely due to the fact that women lose bone density faster than men do, particularly after menopause when the drop in estrogen levels accelerates bone loss. However, men can also develop weakened bones as they age, putting them at risk as well.^[5]

The burden of hip fractures on individuals and healthcare systems is substantial. It is estimated that a patient spends approximately $40,000 in the first year following a hip fracture, and the annual cost of hip fracture care in the United States exceeds $17 billion.^[3] Beyond the financial impact, hip fractures carry a significant risk of death. Between 12% and 17% of patients who suffer a hip fracture die within the first year, and those who survive face a long-term increased risk of death that is twice as high as people who have not had this injury.^[15]

Looking ahead, the number of hip fractures is projected to increase dramatically. In 1990, the global annual occurrence was 1.3 million, but this number is predicted to rise to between 7 and 21 million by 2050 as populations around the world continue to age.^[3] This makes hip fractures an increasingly important public health concern that requires attention to prevention, treatment, and rehabilitation strategies.

What Causes Hip Fractures?

The vast majority of hip fractures in older adults result from falls. These are typically not dramatic falls from great heights, but rather simple household or community falls that occur during everyday activities. An older person might slip in the bathroom, trip on a rug, or lose their balance while walking.^[1][13] Because their bones have become weakened over time, what would be a minor incident for a younger person with strong bones becomes a serious fracture for an older adult.

Most hip fractures are associated with bones that have been weakened by osteoporosis, a condition in which bone tissue gradually breaks down faster than it can be rebuilt, leaving bones thin, brittle, and prone to breaking. In people with osteoporosis, even a simple twisting motion or a minor trip can be enough to cause the bone to snap.^[1][13]

In some cases, the bone may be so fragile that the fracture happens spontaneously while someone is simply walking or standing, without any fall at all. When this occurs, it is sometimes described as “the break occurs before the fall,” meaning the bone breaks first and then the person falls as a result. These spontaneous fractures typically happen in the femoral neck area.^[1]

In younger adults, hip fractures are much less common and usually occur only as a result of high-energy trauma such as a serious car accident, a motorcycle collision, or a fall from a significant height. In these cases, the force of the impact is severe enough to break even strong, healthy bone.^[1][4]

Around 5% of hip fractures occur without any history of trauma. In these situations, doctors look for alternative causes such as pathological fractures, which are breaks caused by underlying disease processes rather than injury. The two most common causes of pathological hip fractures are cancer that has spread to the bone and long-term use of certain medications called bisphosphonates, which can sometimes weaken bones despite being used to treat osteoporosis.^[3]

Who Is at Risk for Hip Fractures?

Anyone can break a hip if they experience severe enough trauma, but certain people face a much higher risk than others. Age is one of the strongest risk factors that cannot be changed. The risk of hip fracture increases dramatically with advancing age, with people over 85 being ten times more likely to break a hip compared to those aged 60 to 69.^[15]

Women are at considerably higher risk than men, experiencing hip fractures about three times more often. This is primarily because women tend to lose bone density more rapidly than men, especially after menopause.^[5][15] Additionally, women often live longer than men, giving them more years during which they are vulnerable to falls and fractures.

People who have already had one hip fracture face an increased risk of having another. Similarly, having a family history of hip fractures raises your risk, suggesting that genetic factors play a role in bone strength and fracture susceptibility.^[15] Lower socioeconomic status is also associated with higher hip fracture risk, possibly due to factors such as poorer nutrition, less access to healthcare, and unsafe living conditions.^[15]

Health conditions that weaken bones are major risk factors. Osteoporosis and osteopenia (a less severe form of bone loss) make bones fragile and more likely to break. About 2 million Americans experience fractures each year because of osteoporosis.^[6] Other medical conditions can also increase risk, including thyroid disorders, celiac disease, cancer, and rheumatoid arthritis.^[4]

Risk factors linked to falls in elderly populations include a previous history of falls, the need to use walking aids, and taking certain medications. Drugs such as antiepileptic medications, selective serotonin reuptake inhibitors (used for depression and anxiety), sedatives, proton pump inhibitors (used for heartburn), loop diuretics (water pills), and levothyroxine (thyroid medication) can increase fall risk by causing dizziness, drowsiness, or postural hypotension (a sudden drop in blood pressure when standing). Some medications can also reduce calcium absorption or decrease bone density over time.^[3][15]

Lifestyle factors also matter. Having a low body mass index, being physically inactive, and having a poor diet that is low in calcium, protein, and vitamin D can all weaken bones and increase fracture risk.^[4] Unsafe home environments with obstacles, loose rugs, poor lighting, or lack of accessibility features like grab bars can make falls more likely.^[4]

Recognizing the Symptoms of a Hip Fracture

Hip fractures usually cause symptoms that are hard to miss. The most common symptom is severe pain in the hip or groin area that typically worsens with any movement of the hip. Many people find the pain so intense that they are unable to put any weight on the affected leg or walk at all.^[4][5]

When you look at someone who has broken their hip, you may notice visible signs that something is wrong. The hip area often becomes swollen and tender to the touch, and bruising typically develops around the hip and upper thigh. The injured leg may appear shorter than the other leg, and it often turns outward or inward at an unusual angle. You might also see or feel a noticeable bump or deformity in the hip area.^[4][14]

Most people with a hip fracture find it impossible to get up from a fall on their own. They cannot stand, walk, or bear any weight on the affected side. The inability to move normally after a fall is a key warning sign that a hip fracture has occurred.^[5][14]

In some cases, people may hear or feel a snap or pop in the hip when the bone breaks. There may also be a grating sensation called crepitus, which is caused by the broken ends of bone rubbing against each other. In severe cases, patients may experience signs of hypovolemic shock (dangerously low blood pressure due to blood loss) because of bleeding around the fracture site.^[16]

If you or someone you know experiences severe hip pain after a fall or injury, cannot walk or put weight on the leg, or notices any tingling or loss of feeling in the hip or leg, it is crucial to call emergency services immediately or go to the hospital right away. Hip fractures require urgent medical attention and cannot wait for a regular doctor’s appointment.^[14]

Can Hip Fractures Be Prevented?

While not all hip fractures can be prevented, there are many steps you can take to reduce your risk significantly. Staying physically active is one of the most important things you can do. Regular exercise, especially activities that strengthen muscles and improve balance, can help prevent falls. Weight-bearing exercises like walking also help maintain bone strength and density.^[8]

If you have been diagnosed with osteoporosis or osteopenia, taking medication as prescribed by your doctor can help make your bones stronger and less likely to break. These medications work by slowing down bone loss or helping your body build new bone tissue. It is important to discuss with your doctor whether medication to treat bone loss would be appropriate for you.^[8]

Making your home safer can greatly reduce your risk of falling. This might include removing tripping hazards like loose rugs and clutter from floors, improving lighting throughout your home, installing grab bars in bathrooms, and using non-slip mats in the bathtub or shower. Having a home safety check performed by a healthcare professional can help identify potential hazards you might not have noticed.^[4][8]

Good nutrition plays an important role in bone health. Making sure your diet includes adequate amounts of calcium, vitamin D, and protein can help maintain bone strength. If your diet is lacking in these nutrients, your doctor might recommend supplements. Avoiding excessive alcohol consumption and not smoking are also important for maintaining healthy bones.^[4]

Regular vision checks are important because poor eyesight can increase your risk of tripping and falling. If you wear glasses or contact lenses, make sure your prescription is up to date. Similarly, having your doctor review all your medications periodically can help identify any drugs that might be increasing your fall risk or affecting your bone health.^[3]

If you have already had a hip fracture, many of these preventive measures become even more important. Following a fracture, your doctor may arrange for a formal fall-prevention assessment to help protect you from future injuries.^[15]

How the Body Changes When a Hip Fractures

When a hip fracture occurs, it sets off a cascade of changes in the body that go far beyond just a broken bone. The immediate physical change is the break itself, where the continuity of the femur is disrupted. This break can occur in different patterns such as a clean break straight across the bone (transverse fracture), an angled break (oblique fracture), a spiral-shaped break, or a shattered bone with multiple fragments (comminuted fracture).^[4]

The fracture causes severe pain because the broken bone ends are moving against each other and irritating surrounding tissues. Bleeding occurs at the fracture site, which can lead to significant swelling and bruising. Blood vessels, nerves, and soft tissues around the hip may be damaged by the broken bone fragments or by the original trauma that caused the fracture.

One particularly serious complication of certain hip fractures, especially femoral neck fractures, is disruption of blood supply to the femoral head. The blood vessels that nourish the ball portion of the hip joint can be damaged when the bone breaks. If blood flow is cut off, the bone tissue in the femoral head can die, a condition called avascular necrosis. This complication can make treatment more complex and may require hip replacement rather than simple fracture repair.^[6][16]

Being unable to move because of the fracture creates additional risks for the body. Prolonged bed rest can lead to serious medical complications including pressure sores (bed sores) from lying in one position too long, blood clots forming in the leg veins (deep vein thrombosis) because blood is not circulating properly, and pneumonia from not being able to breathe deeply or move around. In elderly patients, extended bed rest can also cause confusion and disorientation, which makes rehabilitation and recovery much more difficult.^[1][13]

The body’s stress response to injury and surgery can affect other organ systems. Blood pressure may drop if bleeding is significant. The immune system activates to fight potential infection, which is why fever sometimes occurs. Appetite often decreases, and patients may become dehydrated if they are not drinking enough fluids. In older adults with multiple existing health conditions, a hip fracture can trigger worsening of other medical problems such as heart failure, diabetes, or kidney disease.

The inability to bear weight on the injured leg changes how the body distributes forces during any movement. Muscles around the hip may go into spasm as they try to stabilize the area. Other parts of the body, such as the back and the uninjured leg, may be strained as a person tries to compensate for not being able to use the fractured hip. Over time, if mobility is not restored, muscles throughout the body can weaken from disuse, making recovery even more challenging.