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March 15th, 2010
05:00 PM ET

Hip fractures more deadly to men

By Saundra Young
CNN Medical Senior Producer

Editor's note: In a previous version of this post, the form of zoledronic acid that reduced death rates by 28 percent over a three-year period was inaccurately identified. The correct form of the drug is Reclast

Hip fractures. They're breaks in the upper part of the femur or thigh bone, most often caused by a fall. People 65 and older are most vulnerable, and according to the American Academy of Orthopedic Surgeons, women have two to three times as many fractures as men. But a new study in the Annals of Internal Medicine says men are at greater risk of dying because of it.

Hip fractures are more deadly for men.

Hip fractures are more deadly for men.

Researchers looked at 39 studies involving nearly 600,000 women and 155,000 men over the age of 50, with hip fracture. They found that while older women are nearly six times more likely to die after a fracture than a woman without a break, older men are about eight times as likely to die in the first three months after their injury.

"Hip fractures are associated with a substantially increased risk of death for both men and women which lasts for at least 10 years after the fracture," said Dr. Cathleen Colon-Emeric, one of the study authors at Duke University Medical Center in Durham, North Carolina. "This highlights the importance of interventions which reduce operative complications and the physical decline that frequently results from a hip fracture."

Researchers are not quite sure why the risk of death increases. But Colon-Emeric says hip fracture is a major blow to your body. "People with hip fractures tend to be more frail. Many have underlying medical problems that put them at higher risk of death, like stroke, Parkinson's disease and dementia."

Earlier studies found that after a hip fracture men are more likely than women to die of infectious conditions such as sepsis and pneumonia.

Only 25 percent of these fractures occur in men. Dr. Jay Magaziner, chairman of the Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland in Baltimore, and a study co-author, says if you project forward to 2050, there will be as many hip fractures in men as there are currently in women today. "We know that men who fracture their hip are generally a bit sicker. They have more medical conditions at the time of their fracture than women. One of the reasons that we believe that is the case, is the natural process of aging post-menopausally in women."

Magaziner says the combination of falling and weak bones will create a hip fracture. He says women lose a little bit of bone each year after menopause, but men don't lose bone naturally. In fact, in order for men to lose enough bone to have a break when they fall, they generally have to have an underlying medical condition. "Women who fracture don't have these other medical problems, so that may be one of the reasons that we're seeing a higher mortality rate in men than women."

Dr. Sandra Fryhofer, an Atlanta, Georgia, internist and past president of the American College of Physicians, says the study is a wake-up call that men can get osteoporosis too. "It stresses the importance of prevention, making sure people are getting calcium, vitamin D and weight-bearing exercises like walking. Anything that puts weight on the bones, because that stimulates new bone formation."

Because men have not received a lot of attention on hip fracture and osteoporosis, Magaziner is working on new research to try to better understand the disparities. "If we can understand the differences in the way men and women respond to having a hip fracture then we can tailor our treatments to these differences and the way people recover," he said. "We want to individualize the way we treat patients."

Colon-Emeric says one treatment has proved to reduce mortality after fracture, an osteoporosis drug zoledronic acid or Reclast. It's made by pharmaceutical giant Novartis and new data show it reduced death rates by 28 percent over a three-year period. It's given once a year intravenously in a doctor’s office and it reduced the chance of additional fractures by 20 percent in a two-year period. Promising, because statistics show one in five will re-fracture their hip.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


soundoff (39 Responses)
  1. ignored

    Mens health is sadly ignored and neglected. The differences in average life expectancy between men and women in 1900 was statistically insignificant yet we accept mens much shorter lifespan as normal and acceptable in the 21st century.
    Men have higher death rates for all 10 leading causes of death there is no federal office of men’s health!
    Although a woman is only 14 percent more likely to die from breast cancer than a man is from prostate cancer, funding for breast cancer research is 660 percent greater than funding for prostate cancer research

    March 15, 2010 at 22:23 | Report abuse | Reply
  2. Bob McKenna

    My tenant, a male, was both physically active and well as sexual, so he told me. One day after fishing with friends, he slipped as he was opening the hatch to his SUV. Somehow, he fell back and hurt his hip. He drove himself to the hspital where he was diagnosed with a fracture of the hip.
    I went to visit him three days later only to fine him in ICU because he had a stroke during the night. Two days later I visited him and he was in worse shape because he had an additional two strokes during that previous night. He died thirty days later. I believe your article may open a few eyes. Thanks for printing it.

    March 15, 2010 at 23:31 | Report abuse | Reply
  3. Tom Rice

    No mystery. Hip fractures, or any trauma including surgery from roughly the knees to the gut, deal with men's larger veins, and thus enhanced vulnerabity to blood clots breaking off, traveling upstream to the heart, and lodging in the pulmonary arteries in the lungs, blocking exchange of oxygen and carbon dioxide. It's called a pulmonary embolism (PE), and kills quickly and is hard to diagnose.
    Anti-coagulants are hard to manage because the doctors want the heavily traumatic wounds to heal, but not engender dislodged clots.
    Thomas G. Rice
    President and CEO (retired) of Medasonics.

    March 16, 2010 at 01:00 | Report abuse | Reply
  4. Not In A Wheelchair Yet

    600,000 women vs 155,000 men? Anyone else see this? They found that while older women are nearly six times more likely to die after a fracture than a woman without a break, older men are about eight times as likely to die in the first three months after their injury. Is it me or does this study spin? Why is it "older women" vs women without a fracture at all??? how the HELL does that make sense??? Versus Older Men who are more likely to die,....not verses other older men who have not had fractures but just in general when you consider those older men who have broken a hip vs those older men who broke a hip an died. I love men, I love my husband and am on him like a wolf when it comes to his health and cholesterol, colon .. ect.. have a son and a daughter I'm on them constantly about preventative medicine appointments. But This .. this 'study' .. sorry don't get it. Maybe I'm old and paranoid but it seems like more 'words' used to secure funds for millions of dollars in research that honestly could be spend in more needed areas.

    March 16, 2010 at 01:59 | Report abuse | Reply
  5. MWA

    This is a very interesting article. Not too long ago, about a year ago now, my 95-year-old grandmother fractured her hip. I was worried that she would have health problems that would take a turn for the worse. That has not happened. In fact, the fractured healed. My grandmother has always been an athlete. Up until the fracture she still would walk at least 20-30 minutes a day. A decade before she would be dancing every night. In her younger days, 60s and 70s, she was playing tennis and would walk to the courts. And until she started having children beginning in her 20s (she had nine kids, by the way) she was a swimmer and played softball. Whenever I would visit her, there was never any junk in her fridge. Milk, fresh fruits, vegetables, fish and rice. She's always drinking water or tea. Seldom any processed sweets. And she never takes supplements. The only thing I've seen her take was medication for high blood pressure. I really do think there is something to exercise and eating healthy. She has outlived my grandfather now by nearly 30 years. I can only hope to live half as long. Way to go grandma!

    March 16, 2010 at 02:08 | Report abuse | Reply
  6. Mary Kay Messner

    The article is interesting but doesn't tell me something I've always wondered about: Specifically, WHY does ANYBODY die from a hip fracture? (Thanks)

    March 16, 2010 at 02:53 | Report abuse | Reply
  7. Cathie L

    My mother is 83 and currently has a pelvis fractured in 3 places. The recovery is incredibly slow- MONTHS. Women need to take their calcium! She does, or it could have been worse. If you get a chance, make a card and give it to nurses for a senior in rehabilitation- they have a really depressing day and it's grueling with therapy.

    March 16, 2010 at 03:58 | Report abuse | Reply
    • Osman

      I also have a femoral neck frtucare mine started as a stress frtucare at Mile 10 of a 12 mile run. And because I thought I had pulled a muscle in my groin area, which is where the pain was, I laid on my couch for 2 days in terrible pain, icing the groing, and then went for an x-ray. The radiologist told me to go straight to emergency, that I had a complete displaced femoral neck frtucare. I had emergency surgery that night and he 3 screws put in. I am now 3 months post surgery. I am walking without crutches, and my goal is to be running in January. I still have a limp. I am wondering if January is too soon, but I am dying here, not doing my long runs with my group! They are all doing the Calif. Marathon this weekend, which is what I was training for. This so sucks!! Does anyone have any input as to why this type of facture happens? Is it my form? any suggestions?I have done 2 half marathons, 4 5-k's, and I was training for a marathon when this happened. I have been running for 20 years, but in the last year I really got more into the long distance running. I am so wanting to get back to my long runs. They made me feel so great!!! Nothing like that feeling after a 12-14 mile run!!Any input would be great. I would love to get a running coach for some one on one help to get me going again. Where would I find someone like that?Any help would be appreciated. Thanks!

      September 13, 2012 at 23:04 | Report abuse |
  8. MikeC

    Maybe the hip fractures are not the cause of death, but people succeptable to the hip fractures are in such a degraded health condition to make themselves more succeptable to fracturing their hip. Maybe hip fractures are just another symptom of poor health.

    March 16, 2010 at 07:57 | Report abuse | Reply
  9. Chuck

    Can "Zomenta" be give once a year, say after age 65 as a prevenative measure to not break a hip?

    March 16, 2010 at 09:21 | Report abuse | Reply
  10. Jeff

    The old saying in orthopaedics is "a person comes in the world through the hip and goes out of the world through the hip". In a lot of cases the association is backwards of what you state above. The reason a person breaks a hip is because of decline in their mental and/or physical well-being. Numerous patients that fall and break a hip are minimal ambulators or have chronic health problems or problems with orientation/balance. So the physical decline has ocurred "BEFORE" the hip fracture, and is only accentuated by the fracture. A lot of patient's families ask how long it will be before the patient is walking and better. Well, if the patient was barely walking before the fracture, just think of the up-hill battle. True, there are a subset of patients who break their hip and then decline, but the vast majority I treat in rural America are already on the "decline"....your prevention recommendations above are key, but does "father time" eventually overcome this as well? Quality of life both before and after hip fracture should be the objective. As far as men, some of the most osteoporotic fractures I see are in men. The number of fractures is 4:1 women over men in your study and in what we see, probably because women outlive men, and also seem to stay independent at home a lot longer than women. Thanks for bringing the subject forward!!!!!

    March 16, 2010 at 10:25 | Report abuse | Reply
  11. Jeff

    The above should say probably because women outlive men, and also seem to stay independent at home a lot longer than men(not women)...Lots of 80 and 90 year old ladies live alone at home. Rare to see same age man living alone here in rural America. Would be a great expose...the independent little ladies over 80. They are amazing.

    March 16, 2010 at 10:37 | Report abuse | Reply
  12. Jeff

    Mary Kay, The reason patients die after a hip fracture is from medical reasons, not the fracture/bleeding/infection. Where I trained, it was taught that HIP FRACTURES ARE A MEDICAL CONDITION/DISEASE, NOT A SURGICAL/INJURY PATIENT....these patients are admitted to the internal medicine service, and surgeons repair the hip quickly so as to get the patient out of bed, moving as early as possible. The reason for death is the underlying medical problems in most cases. These include pulmonary, cardiac, etc. However, patients mentation may be the most important. Take a person who is slowly not walking outside, having bouts of pneumonia or bouts of confusion, they fall and break their hip...they don't have the mentation to motivate to sit up/walk, etc. 2 choices-–repair the hip and help them get up and clear their mind as quickly as possible--let them lie in bed where they will never get up...It is unfortunately in a lot of cases, the patient's underlying condition, mental faculties, and motivation that are a lot more relevant to survival than some omission of some type of care after repair of the hip. A team of 4 to 5 people constantly moving the patient, helping them, etc. may help, but ultimately pneumonia, blood clots, etc. occur from patient not moving and thinking....we do our best at helping them overcome this event in their "medical condition" not injury, so to speak. Thanks

    March 16, 2010 at 11:35 | Report abuse | Reply
  13. Warren Vidrine

    Thanks Jeff for the information above. My dad broke his hip in February and did not recover. He died 2 weeks after the fracture. He had severe osteoperosis and was 92 years old. When the doctors got ready to do the surgery they found that his heart was not strong enough for him to make it. The cardiologists tried different things to get his heart out of a-fib but nothing seemed to work. At this point all we could do was make him comfortable and be with him in his final days. He was walking fine with a walker before this happened but at his age I think it was too traumatic for him to overcome. I knew fracturing a hip was bad but after reading you posts I am not surprised he didn't make it. Sounds like the trauma can trigger other underlying problems. Thanks

    March 16, 2010 at 16:52 | Report abuse | Reply
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      December 28, 2018 at 20:16 | Report abuse |
  14. Greg

    As a surgeon who cares for elderly patients with hip fractures, I agree with Jeff's comments regarding the fact that the patient presenting to the hospital with a hip fracture often gets there because of the fracture itself, but there are many underlying problems that may have precipitated the situation causing the fracture. Many of these patients are already sick, have high blood pressure and dehydration, and are often taking multiple medications, all of which can precipitate dizziness or lightheadedness leading to a fall.

    Dr. Magaziner either is mistaken or was misquoted in the above article. Men also lose bone mass, just like women do, starting at or around the age of 25. However, women's rate of bone loss is accelerated after menopause for about 7 years or so. This makes elderly (postmenopausal) women have lower total bone mass than elderly men. Part of the reason that hip fractures are more common in women than in men is related to this. The other part has to do with the fact that life expectancy for women is about 7 years longer than that of men. So, women live longer with lower and lower bone mass, making fracture more likely. If men were to live on average 14 years longer (accounting for differences in rate of bone loss AND life expectancy), all other things being equal, there would likely be parity of hip fracture prevalence between men and women.

    Unfortunately, Mr. Rice's comment regarding the size of men's veins (as compared to women's) and the risk of death being exclusively related to pulmonary embolism is factually incorrect. Although pulmonary embolism and venous thrombosis (clots) are serious issues in any trauma patient, especially those with hip and/or pelvic fractures, there are multiple other causes of death that have nothing to do with pulmonary embolism. Pulmonary embolism is not the exclusive answer. I challenge him to present data related to the size of veins and how that is related to venous thrombosis and pulmonary embolism, and how that is directly related to the apparent increase in early death for elderly men with hip fracture.

    March 17, 2010 at 09:17 | Report abuse | Reply
    • Osman

      I should have been on 6 mtnohs before) and to use a bone stimulator to assist in bone growth. Now I am forced to be sedentary (only upper body strength training or ergometer) and use crutches always. No swimming, biking, yoga, stretching, or even walking to the mailbox! If I do not heal by the time of the next bone scan, the doctor will likely order me to remain on crutches an additional 6 weeks after which I will have an MRI. Should the MRI reveal the FNSF, he will likely recommend pinning surgery. This is the worst injury ever and really needs no weight-bearing whatsoever. I wish the first doctor had put me on crutches to heal this fracture immediately, but now surgery is more of a likelihood. The mediocre first opinion has extended recovery so much longer than was necessary had I been on crutches immediately. I just gave up my SF Nike 1/2 marathon for October and am wondering if I will be able to run Boston 2010. Not feeling confident about that at this moment. Good luck with this injury and I hope you are running (or walking without crutches!) soon.

      September 13, 2012 at 23:18 | Report abuse |
  15. veronica Muller

    My father is 85 and has fallen and fractured his hip. He was a pretty good healthy man until then, I was surprised he fractured his hip when he fell as you hear more about women and fracture–I thought mostly from osteoporesis. Interestingly, my father has/had prostrate cancer and has been receiving "female hormones." Could this be the reson for a hip fracture? Could these hormones produce a "menopausal osteoporis" causing bones to be more fragile? He, too, is suffering from complications from the hip repair surgery. No one dies from a hip fracture. They die from complications following it. That is what we are dealing with now.
    Princeton

    June 5, 2010 at 21:04 | Report abuse | Reply
    • Gordon

      Hi, I am just wondering how your father is doing now. My father just fractured his hip and is 85 years old, as well.
      I hope your father is doing well, as my father is just beginning the recuperative phase.
      Thanks.

      February 19, 2011 at 22:02 | Report abuse |
    • Rizki

      I had exactly the same iujrny several years ago when I started running again after college. I could barely lift my leg off the table in the doctor's office and was limping when I was walking. A little while (maybe a month or so) later I started cross-training with walks. I could still feel something wasn't right then but I would test it with jogs here and there, but didn't start running on it again for a year and a half!! I wish I had gone to a physical therapist, maybe I would have recovered sooner. Now I am training for my third marathon and am always conscious about my entire body. My overtraining had caused my iujrny and I'm not going to let that happen again!! I know it's a bummer not running. Keep your head up, though, and see a physical therapist!!

      September 13, 2012 at 23:46 | Report abuse |
    • Janet

      My dad had prostate cancer and was given hormones that caused osteoporosis. He had a stroke 4 years ago and last night he fractured his hip. He has heart problems and high blood pressure. He's 87. Surgery today, went well they say. After reading everything here, I am afraid that he won't be around much longer. I hope this is not the outcome, but he was moving very slowly with a walker before last night's fall. I find this all very depressing and discouraging. Is there any hope? Is there anything I can ask his doctors, therapists to do when I visit tomorrow?

      October 1, 2015 at 22:29 | Report abuse |
  16. virginia bell

    my husband has been diagnosed with fx of the femur, he is 83 and the doc is opting for rest as he has been in a wc for a month already. have you ever heard of this.

    June 25, 2010 at 10:10 | Report abuse | Reply
    • Nascimeto

      i was diagnosed with a ielcmponte stress fracture of the femoral neck in July 2009, i had pain through running weeks prior to being diagnosed, i was runnng has a hobby just for fitness for myself and to help with stanima when showing my dogs, i went to the doctors in June and she sent me away with ibufren for a strain and told me to rest, which i did, then after a few weeks i run again, and again the pain returned in my groin, i ran again the weekend after at a dog show, this time after the class i broke down and was unable to put my leg on the ground at all i was in total agony, the next morning in pain i came straight to my computer and put in the symptoms, which came up STRESS FRACTURE!!! i went back to the doctor on the same morning but a different doctor and told him, what had been happening, he sent me straight away for a x-ray, which i had and nothing showed up, i told him nothing may show up if it was a stress fracture, i was given crutches unti my x-ray came back, and guess what nothing showed up, i then told the doctor i was in lots of pain and something wasn't right, he then sent me for a MRI scan which took 1 month before i could be see for the scanned, so by this time 6 weeks had already past by, it also took a further 10 more days for my MRI scan results to come through to my doctors surgery, and as i had guessed i had a substantial ielcmponte fracture of the femoral neck, my doctors face was a picture, he looked at me has if to say how did you know! i know my body and i wasn't being put of this time with ibufren, i went to see a ortherpedic surgeon and i am stil on crutches 4 months down the line, we took a x-ray about 2 weeks ago and it now shows up the fracture which is on the under side and all the way across, i have been taking calcium and Vit D and it has shown on the x-ray this time with new bone growth, so we are going to stay with the crutches till the 20th November, then we will take another x-ray to see how it is progressing and maybe to start some theraphy if its looking better.I cannot wait to start to jog a little again its driving me mad i am a very active person, now doing nothing!!! So i no how you all feel.

      September 12, 2012 at 00:05 | Report abuse |
  17. Catherine

    What amazes me, is that in light of these statistic; why the laws of ADA are now more vehemently enforced? Many of these falls and fractures take place outside the home. Many of these falls are preventable! Public access laws are woefully ignored in this country. The life expectancy is greatly shortened after a fracture, but when advocate bring this to the attention of business owners and proprietors they are accused of extortion or bringing frivolous claims. This is too sad!

    December 22, 2011 at 23:24 | Report abuse | Reply
  18. Frank

    Many women over 75, and most women over 83, should be taking bisphosphonate. If such a public health inisitive was in place hip fractures could be reduced by near 80%. Such an inisitive would be among the most cost effective ever.

    February 1, 2012 at 14:23 | Report abuse | Reply
    • Janet

      biphosophanates do not help, in fact they make things worse. Latest studies show they are very harmful

      October 1, 2015 at 22:31 | Report abuse |
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