What is Life Expectancy After Hip Fracture?

Why focus on life expectancy after a hip fracture?

Many of my patients become very concerned after experiencing a hip fracture, especially if it’s their first fracture ever. Often elderly, these individuals (or their loved ones) have many questions, which might resonate with yours:Will I be able to recover from this? Is there a risk of death? Will I have any lasting effects or complications?

As a healthcare provider, having answers to these questions allows us to better inform those who seek these answers. It’s important to present these answers in the most factual manner possible, while also tailoring the response to the expectations and individual situations of each person.

This article aims to provide you with reliable data regarding the risk of mortality after a hip fracture, enabling you to make informed decisions for yourself or your patients.

How do we determine life expectancy after a hip fracture?

There are several ways to get an idea of the mortality rate following a hip fracture. Here’s the approach I believe provides the most reliable and accurate information:

• Track the progress of the largest possible number of individuals who have experienced a hip fracture. This goes beyond just my small sample of patients I see as a physical therapist.
• Compare their outcomes (including the frequency of death or complications) to the outcomes of similar individuals (age, gender, health status, etc.).

Multiple research teams in most countries around the world are actively working to gather this type of data from hospital and clinic records. To inform about life expectancy after a hip fracture, I have reviewed the findings from these national and international publications.

Data on life expectancy after fracturing the hip

To date, there are hundreds of studies dedicated to this topic in the international medical literature, along with numerous publications that summarize these studies:

For the purpose of this article, I selected study syntheses that, in my opinion, provided better answers to these two questions:

• What is the life expectancy of individuals with a hip fracture in France?
• What do the data from multiple countries (Canada, US, etc.) tell us about this life expectancy and the factors that increase the risk of death after fracturing the hip?

At the end of the article, you will find links to these studies.

Data on life expectancy in France

A significant study was conducted in France in the late 2010s. The research team relied on records of people over the age of 59 who were hospitalized in a French hospital between 2002 and 2013 (Garofoli 2019).

However, their focus was not on studying mortality but rather the frequency of hip fractures. They observed that over a 12-year period, there was a slight increase in hip fractures, even when accounting for the aging population.

Based on data from a two-year period between 2015 and 2017, the mortality rate after a hip fracture in France is 20.2% (Papanicolas 2021).

This means that one year after fracturing the hip, 1 out of 5 people has passed away during that year.

It’s important to note that deaths also occur within the same age group during the year following without experiencing a fracture.

On the official French government websites, you can find the results of another major study conducted in France using patient records from a decade earlier, between 2008 and 2009 (DRESS, 2016).

Here is this data, compared with the one-year mortality rate for individuals who did not experience a fracture.

This study also concludes that people with better overall health before the fracture have a lower risk of mortality.

Data on life expectancy from other countries

A research team from the United Kingdom has explored the past 60 years of academic publications on life expectancy after a hip fracture (Haleem 2023).

Here are their main findings (and some good news 🙂):

• The average age of patients suffering from a hip fracture continues to increase steadily by a little over a year per 5-year period.
• The average age of patients suffering from a hip fracture has changed from:
  • 73 years (1960s)
  • to 81 years (2000s),
  • and 82 years (2010s).
• Over the six decades, one-year mortality has decreased from an overall average of 27% (1960s) to 20% (2010s).

Let’s focus a bit more on this “one-year mortality.” What does this “20% one-year mortality” figure actually mean?

• This means that out of 100 people who have had a hip fracture, 20 of them will pass away within 365 days following the fracture.
• This figure is ideally compared to the mortality of individuals with the same characteristics as these people but who did not have a hip fracture. There will also be deaths among this group, although the number is likely to be lower than 20.

Another research team sought to compare the number of deaths in these two different groups of people (Vestergaard 2009). Here are their main findings:

• Men aged 51 to 60 who have had a hip fracture live an average of 7.5 years less.
• Men aged over 80 live 3 years less.
• Expressed as a percentage, the relative loss of expected remaining years of life was most significant among older subjects, and more pronounced in men than in women.

Here is data from different countries on the one-year mortality rate after a hip fracture (Papanicolas 2021):

Country	One-Year Mortality Rate after Hip Fracture
🇺🇲 United States	26.7 %
🇨🇦 Canada	22.9 %
🇦🇺 Australia	21.5 %
🇫🇷 France	20.2 %

The mortality rate after a hip fracture (not adjusted to the age of the population) is the lowest in France.

The older one is and the more health problems they have before the fracture, the higher the risk of death from a hip fracture.

Life expectancy after a pelvic fracture is identical to that after a hip fracture.

Can the risk of mortality after fracturing the hip be limited?

Numerous studies attempt to identify whether individuals who pass away after a hip fracture:

• have a specific additional illness;
• received a specific medical or surgical treatment rather than another;
• engaged in behaviors that others did not.

The idea behind doing this is to identify things that could be implemented to specifically limit the risk of death after a femoral neck fracture.

Risk factors

At the end of the article, you will find a link to studies that show, for example:

• That having local/regional or general anesthesia for individuals undergoing femoral fracture surgery does not impact mortality.
• That being operated on within the first 48 hours has a better prognosis compared to being operated on later or not being operated on at all (Gonzalez 2022).
• That death is more likely in individuals over 75 years old, especially males, those living in institutions, or those with mild to severe liver diseases, chronic kidney diseases, COPD, dementia, heart failure, diabetes, vision and hearing impairments, and incontinence (Guzon 2019).
• That obese or overweight individuals are less likely to die after a femoral fracture compared to those with a “normal” body mass index (BMI). Individuals with a lower than normal BMI have a higher risk of mortality than those with a “normal” BMI (Li 2022).

What are the factors that decrease the risk of mortality and that patients or caregivers can influence?

Here are the ones I’ve identified:

• Providing oral protein supplements to all elderly hip surgery patients (Gonzalez 2022).
• Quitting smoking, especially if you are over 60 years old (Zhang 2022).
• Early mobilization: Moving as soon as possible after the fracture.

I’ll delve a bit more into this last point as a physiotherapist, as it is very relevant to me.

Early mobilization (alone or with pysical therapist or an other person)

Early surgical intervention should be accompanied by the swift mobilization of the elderly individual from their bed and combating immobility (Sallehuddin, 2021). Indeed, the longer the period of immobility in bed, the higher the risk of:

• Pneumonia
• Delirium
• Disability
• Mortality

Early mobilization within 36 hours of the surgical intervention is associated with nearly doubling the rate of hospital discharge 30 days after the intervention (Sallehuddin, 2021).

But what do we mean by “early mobilization”? There is no clear consensus on this. A commonly given definition is the ability to sit up or get out of bed.

In healthcare settings, it’s often discussed to “get people into a chair” the day after surgery. Whether it’s done with the help of a physiotherapist or another caregiver, it doesn’t seem to visibly impact recovery.

That’s already a good first step, but the idea is to go even further by encouraging more mobility, even in individuals with cognitive impairments (provided, of course, that they are willing).

Consent is indeed a real issue, especially for those with cognitive impairments. How far should caregivers encourage them? What should be done if family members are eager for engagement, but the individual themselves is not?

I obviously don’t have a ready-made answer to this question. It’s a topic I often discuss with the family members of those I support, but it’s not an easy subject.

Summary: What is the risk of death one year after a hip fracture?

While reading or skimming through this article, you’ve probably noticed that approximately 1 in 5 individuals dies within a year following a hip fracture. However, this mortality rate should be considered in relation to factors like age and other existing health conditions.

If you are in relatively good health at the time of the fracture, regardless of your age, the risk of dying within the following year is lower. In this case, the mortality rate approaches that of the general population of the same age without a fracture.

One of the key factors that individuals, their loved ones, or caregivers can influence to reduce the risk of death after a hip fracture is to encourage, as much as possible, getting out of bed and promptly resuming as many activities as possible.

Physical therapists are among the healthcare professionals who can assist with this. However, the entire medical and paramedical team, along with the support network, plays a role in this effort.