A broken hip is more deadly than cancer.
The statement may prompt a doubtful double-take, but it’s borne out by new Canadian research.
Fewer than one-third of men over the age of 65, and half of women over 65, are still alive five years after a fracture, according to a study published in the medical journal JBMR Plus.
By comparison, the five-year survival rate for older adults is 85 per cent for men diagnosed with prostate cancer, 80 per cent for women with breast cancer, and 56 per cent for colon cancer.
The study, led by Dr. Jacques Brown of the CHU de Québec Research Centre, examined records from 98,474 Ontario residents aged 66 and over who suffered fractures between 2011 and 2015. Their median age was 80, and three out of four of them were women.
People break all manner of bones – wrists, arms, vertebrae, etc. – but broken hips are both the most common and the deadliest. Researchers noted that while women have much better survival rates than men after hip fractures, women are also far more likely to break bones in the first place.
Saying that hip fractures are more deadly than cancer is a crude, simplistic comparison. But it serves to draw our attention to many issues related to aging, and how we don’t always take certain health issues seriously.
There were 34,145 people over the age of 65 hospitalized for treatment of hip fractures in 2022-23, according to the Canadian Institute for Health Information.
That’s an enormous number, and an enormously costly health issue. Follow-up care for a hip fracture costs, on average, $63,649 according to Canadian research.
Surgeons can put broken bones back into place using screws, nails, rods or plates; they can replace the damaged hip joint with an artificial one; or do a complete hip replacement.
Hip fractures are costly because hospital stays tend to be long – one to four weeks on average – and often lead to a cascade of other issues, as already-frail patients become deconditioned and suffer additional ailments like delirium. Physiotherapy is also essential.
Still, 40 per cent of elders who break a hip never walk independently again. They require walkers, scooters or wheelchairs.
The new research notes that the first month after a broken hip is the most deadly period, and a large number of deaths occur within the first year after the break.
In fact, for many, a hip fracture marks the beginning of the end.
Fewer than half of people hospitalized with a hip fracture go home again: 44 per cent return to the community, 27 per cent to a rehab facility, 17 per cent to long-term care, and 10 per cent to another hospital.
Older people who fall and break bones such as hips usually have a whole bunch of other stuff going on, including osteoporosis that leaves their bones brittle. One in three women and one in five men will suffer an osteoporotic fracture in their lifetime.
Elders often fall as a result of other medical conditions like dementia or heart disease, or because of drug interactions, or a risky physical environment.
In the new Quebec paper, Dr. Brown says one of the main takeaways of the data is the need for better fracture prevention, which principally means fall prevention.
Parents of babies and toddlers childproof their homes to keep kids from danger. Similarly, we need to elderproof homes to protect frail seniors. Same goes for hospitals, where falls and fractures are all too common.
Grab bars, railings, non-slip flooring, better lighting and removing obstacles and dangerous items like throw rugs, and ensuring people wear sensible (non-slip) footwear, are all basic ways to help prevent deadly falls.
There are programs wherein nurses or occupational therapists visit homes and provide advice on making them safer, but this kind of investment in prevention is not nearly common enough. Nor is the promotion of physical activity in older adults. A little bit of exercise can make an enormous difference in keeping people more steady and sturdy on their feet.
An Australian study, during which researchers have followed a large group of seniors with osteoporosis for decades, found that a small increase in bone density (3 per cent) leads to a dramatic decrease in hip fractures (45 per cent).
We invest a lot in cancer prevention and care, and rightly so. But the new data are a reminder that we should be equally concerned and proactive in preventing both falls and brittle bones.