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Health & Exercise Forum

Hip Fracture Prevention –More Than an Orthopedic Problem

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Feb 24, 2014

Dr. Mackarey's Health & Exercise ForumMy grandmother, Rosina Scalese, lived to the wise old age of ninety- seven. I have inherited her coveted “pock a book” in which she always kept one dollar bills to give to any child kind enough to visit her. Now, I find myself hoping to inherit another prized possession from my grandmother… her longevity genes! She lived independently until she was 90 years old. She enjoyed walking all over her North Scranton neighborhood visiting her lifelong friends, Mrs. Costanzo and Mrs. Bonacci. She walked to Rossi’s Market to shop for groceries and Murazzi’s for suprasatta and provolone. Unfortunately, my grandmother’s independence was lost the same way more than one-third of a million people lose theirs… hip fractures! What I did not know then, that research shows now, is that her fracture, like many, was more than just an orthopedic problem. It involved age, gender, diet, exercise and vestibular problems (inner ear problems effecting balance).

Injuries due to falling are a very common problem in the elderly. Hip fractures are the most common injury due to falling in the elderly. According to the Centers for Disease Control (CDC), more than 300,000 persons over the age of 65 will fracture a hip in the United States this year and 18 to 33 percent of those who are older will die within one year of their fracture.  Furthermore, approximately 25 to 75 percent of those who were independent before their hip fracture will not walk independently (50 percent will require a cane or walker) and will not attain their prior level of independence, requiring family assistance or home care. It costs an average of $37,000.00 per hip fracture or more than a billion dollars a year.

Several risk factors for hip fractures have been identified. While some factors are somewhat controllable and may improve bone quality, (diet, exercise, smoking, alcohol) others are not.

Common characteristics of persons who are vulnerable for hip fractures:

**Some risks are due to osteoporosis and others from balance problems

  • Age: Risk increases with age 65 and older
  • Gender: Women are 2-3 times more likely than men
  • Heredity: A family history of hip fractures with age
  • Race: Caucasians and Asians are at greater risk, especially small-boned & slender
  • Nutrition: A low calcium diet or reduced ability to absorb calcium
  • Personal Habits: Smoking or excessive alcohol use increases risk
  • Physical Impairments: Physical frailty, arthritis, poor balance & coordination, Vestibular or inner ear problems
  • Mental Impairments: Senility, dementia, Alzheimer’s disease
  • Medication: Some may cause weakness or dizziness
  • Poor Balance & Coordination
  • Deconditioning: Poor fitness level and slow walking speed

A recent study by the American Physical Therapy Association found that patients benefited from a physical therapy evaluation to determine their risk level for falling. If a high-risk level is found on a falls assessment, physical therapy interventions can be successfully employed to improve strength, balance, and coordination and falls prevention. Also, a well-balanced diet, exercise, Calcium with vitamin D supplements and medications can help prevent or retard osteoporosis and prevent hip fractures.

Balance & Coordination Exercises:

***Always perform slowly, alternate right and left sides, limit other distractions and concentrate on the exercise to retrain the brain, 10-20 times each 2-3 times per day. Please use supervision or assistance if necessary.

Lying on Back:

  • Knee Slide: Slide heel up toward chest 70 degrees, then lower back down
  • Shin Slide:  Slide heel up and down the opposite shin
  • Hip In & Out: Slide heel out like a scissors 12 – 16 inches and back in to midline


  • Marching: Lift foot off floor 4-6 inches
  • Leg Kick: Kick leg up and down
  • Ankle Pump: Pump ankle up and down like a gas pedal
  • Weight Shift: Shift weight from right to left holding position for 5 seconds
  • Head Turns: Turn head slowly right and left – lead with eyes

Standing: **Caution: Do not perform standing exercises without assistance or supervision

  • Marching: Hold onto countertop, lift foot off floor 4-6 inches – repeat with other leg
  • Weight Shift: Hold onto countertop, shift weight right and left holding position for 3-5 seconds – repeat with other leg
  • Walking: Walk forwards, backwards and sideways while holding onto someone’s hands – like dancing the box step.

If you feel you or a loved one may be at risk for falling or a hip fracture, ask your physician if a physical therapy consultation for a falls prevention program may benefit you.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.