Hip fracture

Also called Broken hip, Fractured neck of femur

Around 70,000 a year in the UK. Roughly a third of people die within a year, and the first 36 hours shape the rest.

What it is

Around 70,000 hip fractures happen in the UK each year, overwhelmingly in older people, and almost all after a fall in someone with osteoporosis.

The outcome figures are stark. Around a third of people die within a year. Fewer than half return to their previous level of independence. It is one of the most consequential single events in older people's health.

What determines the outcome is not mainly the fracture. It is what happens around it: surgery within 36 hours, pain controlled properly, mobilising the day after surgery, orthogeriatric input, delirium prevented, nutrition maintained, and bone protection started before discharge.

Every one of those is measurable, and every one is sometimes missed.

Signs you might notice

Pain in the hip or groin after a fall, and inability to weight bear.

The leg on the affected side shortened and turned outward.

But a hip can be fractured and still weight-bear. Any older person with hip or groin pain after a fall, even if they walked afterwards, needs imaging.

In someone with dementia, the sign may be agitation, refusing to stand, or a change in behaviour rather than a complaint of pain.

How it can affect day-to-day life

Pain is under-treated, particularly in people with dementia who cannot report it, and untreated pain causes delirium, which worsens every other outcome.

Deconditioning is rapid. Every day not mobilising costs muscle that an older person may never rebuild.

Bone protection to prevent the next fracture is frequently not started, so a person survives one hip fracture and goes on to break the other.

Supporting someone well

Get them to hospital. Any suspected hip fracture is a 999 or urgent transport matter, and delaying surgery worsens outcomes.

Advocate for pain relief, especially for somebody who cannot ask. Assess pain by behaviour, not by whether they complain.

Push for surgery within 36 hours and for mobilising the day after.

Prevent delirium: glasses on, hearing aids in, familiar people, sleep at night, hydration, and no unnecessary sedation.

Ask before discharge what bone protection has been started. If the answer is none, ask why.

Get up and dressed daily, and keep going with rehabilitation for months, because improvement continues well past discharge.

Fiducia Guardian holds the baseline, the medicines and the care team, which is exactly what a hospital needs at 2am and what a rehabilitation team needs at discharge.

Where to get help

999 or urgent assessment for any suspected hip fracture.

Ask about the orthogeriatric team and about a fracture liaison service.

Age UK and the Royal Osteoporosis Society both help with what comes next.