HIP FRACTURES ARE ON THE RISE, with a new study suggesting that the incidence will nearly double by 2050. The statistic becomes more frightening in this context: At least one in four will die within one year of a hip fracture. Today we look at five ways you can lower your hip fracture risk.
Did you know that osteoporotic hip fractures, a difficult problem for many, will be a growing population as the world’s population ages? A new study provides insights into who is at risk.
First, I have some good news. Based on an assessment of 20 healthcare databases from 19 regions and countries, the hip fracture rate is declining as much as 2.8 percent annually in 11 global regions.
Today, we explore ways to reduce your risk of an osteoporotic hip fracture.
“We have calcium in our bones, iron in our veins, carbon in our souls, and nitrogen in our brains. 93 percent stardust, with souls made of flames, we are all just stars that have people names.” — Nikita Gill
Hip fractures will nearly double by 2050
Ching-lung Cheung of the University of Hong Kong’s Department of Pharmacology and Pharmacy presented the findings at the annual meeting of the 2022 American Society of Bone and Mineral Research.
The researchers evaluated data from 19 countries for individuals 50 and older who had sustained a hip fracture between 2005 and 2018. Here are the research findings:
Total hip fractures will increase over time in 18 of 19 countries. By 2050, the worldwide hip fracture incidence will likely double, with a larger proportional increase among men.
Hip fractures by geography
Hip fracture rates vary greatly by geography. While age-adjusted incidence was estimated to be 180 per 100,000 individuals, the average incidence varied from -2.8 percent to 2.1 percent per year.
The largest drops?
- Denmark -2.8 percent
- Singapore -2.8 percent
- Hong Kong -2.4 percent
And the biggest increases?
- The Netherlands +2.1 percent
- South Korea +1.2 percent
The risk of death within one year of a hip fracture ranged from 14 to 28 percent, with mortality trends ranging from -5.3 percent to 18.4 percent. Australia, the Netherlands, and Singapore had the largest decreases (5.3, 4.6, and 4.3 percent, respectively).
University of Hong Kong co-investigator Dr. Ching-Lung Cheung explains to Medscape Medical News that while “there is a decreasing trend of hip fracture incidence in some countries, such a percentage decrease is insufficient to offset the percentage increase in the aging population.”
What about the use of anti-osteoporosis medicines within a year of hip fracture? Here, the range was great at 11 to 50 percent. Six of 15 sites experienced declines in the use of medicines designed to prevent bone loss. Again, Dr. Cheung:
“Although initiation of anti-osteoporosis medication after hip fracture is recommended in international guidelines, the one-year treatment rate [was] well below 50 percent in most of the regions evaluated. This indicates the treatment rate is far from optimal.”
As Cuvier could correctly describe a whole animal by contemplating a single bone, the observer who has thoroughly understood one link in a series of incidents should be able to accurately state all the other ones, both before and after. — Arthur Conan Doyle
Hip fractures will rise as the world’s population ages. But what can we do to reduce our risk of suffering from the often debilitating condition?
1. Lower your hip fracture risk: Get some physical activity
If you want to keep your bones strong, try a regular weight-bearing activity. As I age, I have shifted away from running to walking. The latter counts as weight-bearing exercise. I especially like that ambulation is associated with numerous health benefits, including the following:
- Bone health
- Muscle strength
- Balance and coordination
All of these can help me to avoid falls and fractures. As I approach the first anniversary of a traumatic fall on ice, I am especially sensitive about this topic. I wrecked my knee, including a complete tear of my patellar tendon.
My shift to regular walking as the core element of my workout routine reminds me that weight-bearing exercise does not mean only weightlifting. Walk, and you bear your weight. Still, I add some strengthening exercises to maintain upper body bone health. Even light weightlifting is an excellent approach to bone and muscle maintenance.
It is a good time for me to remind you of the Physical Activity Guidelines for Americans. Recommendations include adults getting 150 minutes of moderate-intensity physical activity each week. In addition, we should engage in muscle-strengthening exercises at least two days per week.
This is probably a good time for me to remind you of the Physical Activity Guidelines for Americans. Recommendations include adults getting 150 minutes of moderate-intensity physical activity each week. In addition, we should engage in muscle-strengthening exercises at least two days per week.
2. Lower your hip fracture risk: Vitamin D (and vitamin K)
Vitamin D (and the oft-forgotten vitamin K) is essential for bone-building. Vitamin D helps the body absorb calcium. To reduce the risk of adverse bone conditions (such as osteopenia and osteoporosis), we need to achieve a blood level of at least 30 ng/ml (75 nmol/l).
Unfortunately, many of us suffer from vitamin D deficiency, with approximately one billion individuals worldwide not getting enough.
And many of us don’t think about vitamin K. Vitamin K2 supports bone health by modifying osteocalcin. Our bodies use this protein to create bone, with the modification allowing osteocalcin to bind minerals in bones and help reduce bone calcium loss.
You may get adequate vitamin D through sun exposure and food sources (including liver, fatty fish, liver, and cheese). However, many people need to supplement with up to 2,000 IU of vitamin D daily to maintain optimal levels.
Here are the study authors’ words in their piece Calcium Intake and Risk of Fracture: [A] systematic review:
“Dietary calcium intake is not [emphasis added] associated with risk of fracture, and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures. Evidence that calcium supplements prevent fractures is weak and inconsistent.”
Increasing calcium alone (by diet or supplementation) appears insufficient to reduce bone fractures. Moreover, calcium supplementation may not even significantly increase bone mineral density, according to an analysis published in the British Medical Journal.
You may get adequate vitamin D through sun exposure and food sources (including liver, fatty fish, liver, and cheese). However, many people need to supplement with up to 2,000 IU of vitamin D daily to maintain optimal levels.
According to the National Academy of Medicine, an independent nonprofit organization that provides guidelines on several issues, individuals between the age of one and 70 should consume at least 600 international units (IU) per day. At the same time, those over 70 should get 800 IU. Foods rich in vitamin D include salmon, sardines, dairy products, and fortified foods and juices.
Unfortunately, many cannot get adequate vitamin D through food sources. Moderate sun exposure may help, but please be careful not to raise your skin cancer risk significantly. Finally, supplements may help, but check in with a valued healthcare professional.
3. Be careful with very low-calorie diets
Consume too few calories, and you may put yourself at risk for muscle mass loss and bone compromise. Diets that include fewer than 1,000 calories daily can lower bone density in normal and overweight individuals.
A study of obese women consuming 925 calories daily (for four months) demonstrated a significant loss of hip and upper leg bone density, even for those performing resistance exercise.
4. Lower your hip fracture risk: Watch your weight
Keeping a healthy weight can help support bone health. Underweight individuals put themselves at risk of osteopenia and osteoporosis. Postmenopausal women — who have lost some of the bone protection of higher estrogen levels — can be at particularly high risk.
On the other hand, low body weight can contribute to lower bone density and more bone loss in postmenopausal women.
5. Other ways to lower your hip fracture risk
Among other variables influencing bone health are magnesium and zinc. These substances are essential to achieving peak bone mass during childhood. Moreover, they can help you maintain bone density as you age.
Magnesium is key to converting vitamin D into an active form that promotes calcium absorption. Good sources of zinc include beef, spinach, shrimp, flaxseeds, oysters, and pumpkin seeds.
Finally, try to eat lots of vegetables, get adequate protein, and get lots of mega-3 fatty acids through your diet. I will end with the United States Preventative Task Force (USPSTF) recommendations for bone screening:
- Women 65 years and older. The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older.
- Postmenopausal women younger than 65 years are at increased risk of osteoporosis. The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years at increased risk of osteoporosis, as determined by a standard clinical risk assessment tool.
- Men. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men.
The new study reminds us that we need to do better at preventing hip fractures. In addition, after-fracture care remains inadequate. I often post about the benefits of walking and other “moving” physical activities, but I want to remind you of the need for resistance training and more. Oh, one more thing: Practice balance.
Potential conflicts of interest
Amgen funded the new study examining the worldwide incidence of hip fractures. Agen employs one of the study authors. The company makes drugs designed to reduce bone fracture risk.
The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you seek medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.
Thank you for joining me for this look at five ways you can lower your hip fracture risk.
