Looking at the link between hip fractures and rate of death

Q: I know of several older women who have died within a year after a hip fracture. But why? Is this due to a cause and effect of a bone fracture, or something else entirely?

A: Hip fractures are common as we get older. The lifetime risk of a hip fracture in a woman is 17.5 percent; for men, it's 6 percent. Women have greater rates of osteoporosis than men and thus the greater risk of fractures.

Now let's look at why hip fractures increase the rate of death.

Let's start with the most common reason for an older person to get a fracture - a fall.

Such a fall doesn't usually occur from hiking mountainous terrain, but rather from a misstep or a loss of balance within the home.

In fact, 90 percent of hip fractures in the elderly occur because of a fall from a standing position. The loss of balance that precipitates a fall occurs because of weakness in hip girdle muscles, and/or generalized weakness due to illness, medication and/or a prior stroke.

To put it simply, the more debility one has, the greater their chance of falling; the hip fracture is often the consequence of that debility. So this debility, in itself, can be a major reason for the increased death rates seen among people with hip fractures.

Next, the majority of displaced hip fractures will require surgery to repair. The surgery can be either a total hip replacement or a surgery to bring the misaligned pieces of bone together using metal screws, rods and plates.

Surgeries are fraught with possible complications, leading to a greater risk of debility and even death. Complications include blood loss, cardiac arrest, stroke, problems with anesthesia, infection and blood clots.

However, waiting too long to have a surgery for a hip fracture can also lead to prolonged bed rest, resulting in an increased chance of blood clots in the legs, bed sores, urinary tract infections, pneumonia and, again, death.

Another problem, before and after surgery for a hip fracture, is that elderly patients are especially likely to become delirious. One study found that 61 percent of elderly patients with a hip fracture had an acute state of confusion.

This confusion leads to greater agitation, an inability to eat and limited ability to recover from a hip fracture. In addition, confusion can lead to medications to sedate an agitated patient, further delaying recovery.

For some, recovery from a hip fracture can take months. Long hospital and rehabilitation facility stays lead to an even greater risk of complications.

When you add pre-fracture problems to post-fracture problems, it's no surprise that the mortality rates are so high.

A 2017 European study found that, in people older than 60, 15.1 percent of 463 patients died within one year of a hip fracture. A 2010 American study of the same age group found that 21.2 percent of 758 patients died within one year of a hip fracture.

So prevention is crucial. Regular exercise, use of calcium and maintaining good vitamin D levels are absolutely necessary.

So is good overall health. Encourage it in yourself, and do what you can for those you love.

• Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles. Send your questions to askthedoctors@mednet.ucla.edu