Diagnosis

Often your doctor can determine that you have a hip fracture based on your symptoms and the abnormal position of your hip and leg. An X-ray usually will confirm that you have a fracture and show exactly where the fracture is on your bone.

If your X-ray doesn't show a fracture but you still have hip pain, your doctor may order an MRI or bone scan to look for a small hairline fracture.

Most hip fractures occur in one of two locations on the long bone that extends from your pelvis to your knee (femur):

  • The femoral neck. This area is located in the upper portion of your femur, just below the ball part (femoral head) of the ball-and-socket joint.
  • The intertrochanteric region. This region is a little farther down from the actual hip joint, in the portion of your upper femur that juts outward.

A third type of hip fracture, called an atypical fracture, can occur in people who have been treated for a long period of time with medications that enhance bone density (bisphosphonates).

Treatment

Treatment for hip fracture usually involves a combination of surgery, rehabilitation and medication.

Surgery

The type of surgery you have generally depends on the location and severity of the fracture, whether the broken bones aren't properly aligned (displaced fracture), and your age and underlying health conditions. The options include:

  • Internal repair using screws. Metal screws are inserted into the bone to hold it together while the fracture heals. Sometimes screws are attached to a metal plate that runs down the femur.
  • Total hip replacement. Your upper femur and the socket in your pelvic bone are replaced with prostheses. Increasingly, studies show total hip replacement to be more cost-effective and associated with better long-term outcomes in otherwise healthy adults who live independently.
  • Partial hip replacement. If the ends of the broken bone are displaced or damaged, your surgeon may remove the head and neck of the femur and install a metal replacement (prosthesis). Partial hip replacement may be recommended for adults who have other health conditions or cognitive impairment or who no longer live independently.

Your doctor may recommend partial or total hip replacement if the blood supply to the ball part of your hip joint was damaged during the fracture. That type of injury, which occurs most often in older people with femoral neck fractures, means the bone is less likely to heal properly.

Rehabilitation

Your care team will probably get you out of bed and moving on the first day after surgery. Physical therapy will initially focus on range-of-motion and strengthening exercises. Depending on the type of surgery you had and whether you have assistance at home, you may need to go from the hospital to an extended care facility.

In extended care and at home, you may work with an occupational therapist to learn techniques for independence in daily life, such as using the toilet, bathing, dressing and cooking. Your occupational therapist will determine if a walker or wheelchair may help you regain mobility and independence.

Medication

Up to 10 percent of adults age 65 or older who have a hip fracture will have another hip fracture within two years. Bisphosphonates and other medications for osteoporosis may help reduce the risk of a second hip fracture. To avoid side effects that may make oral bisphosphonates difficult to tolerate, your doctor may recommend taking them via intravenous (IV) tubing.

Bisphosphonates generally aren't recommended for people with kidney problems. Rarely, long-term bisphosphonate therapy might cause pain and swelling in the jaw, vision problems, or an atypical hip fracture.

Preparing for your appointment

You may be referred to an orthopedic surgeon.

What to expect

Your doctor may ask:

  • Have you recently fallen or had another injury to your hip?
  • How severe is your pain?
  • Can you put weight on your leg on the side of your injured hip?
  • Have you had a bone density test?
  • Have you been diagnosed with any other medical conditions? What medications are you currently taking, including vitamins and supplements?
  • Do you use alcohol or tobacco?
  • Have you ever had surgery? Were there any problems?
  • Do any of your close relatives — such as a parent or sibling — have a history of bone fractures or osteoporosis?
  • Are you currently living independently?