At Home with Chris Jessen 2018 - 166
ip fracture is the most
common serious injury in
those aged over 60 in the
UK - there were 65,000
fractures in this age group
last year, which cost £1 billion to treat.
So why is the hip so vulnerable and
what are the risk factors?
The top of the thigh bone, or femur,
has a round head that ﬁts neatly into
a cup-shaped socket in the pelvis to
form the hip joint - it's a ball and
socket joint and the one of the largest
joint in the body. The socket is lined
with smooth cartilage allowing
the bones to move past each other
easily without friction.
The hip joint has an incredible
range of movement and can perform
six diﬀerent types of movements:
Flexion and extension: movement
of the thigh forwards and backwards.
Adduction and abduction: thigh
movement inwards and outwards.
Medial rotation and external
rotation: rotation of the thigh inwards
The muscles around the hip joint
are crucial for it to function properly.
The thigh and lower back muscles
work together to keep the hip stable,
aligned and moving, but it's the
muscles of the hip itself that enable
the wide range of movement.
The hip muscles are divided into
three groups - anterior (front), posterior
(back) and lateral (side) - and work
with large ligaments and tendons
around the joint to hold the bones
in place and prevent dislocation.
Then there are the nerves. The large
sciatic nerve passes under the hip's
166 | FEBRUARY 2018
gluteus maximus muscle and down
the leg towards the foot. The nerves
carry motor signals from the brain to
the hip muscles, via the spinal cord,
to enable movement, and sensory
signals about pain, pressure and
temperature from the muscles
back to the brain.
There are also 20 bursae, or ﬂuid
sacs, around each hip joint. They
are lined with a membrane, which
produces synovial ﬂuid that reduces
friction between the tendons, bones,
ligaments and muscles.
WHAT COULD POSSIBLY
Hips can be injured by accident or
they can degenerate because of age,
lifestyle or illness (see box, right).
A broken hip, or fracture, can
happen at any age, but is most
common in the over-65s, particularly
in women with oesteoporosis.
Hip pain that radiates to the
outside of the thigh may be caused by
bursitis (inﬂammation of the bursae).
This makes walking diﬃcult.
Pain can also be caused by a labral
tear in the cartilage that covers the
outside bony rim of the hip socket.
This can occur as the result of
repetitive wear and tear of the hip
and can be seen in the early stages of
osteoarthritis. It can also be caused
by an injury such as a fall or accident
that causes twisting of the joint.
Dislocation occurs when the
rounded head of the femur comes out
of the hip socket, causing severe pain.
It usually takes some force for this to
happen, such as a car accident.
AGE This is the most common
risk factor for hips, as bone
density and muscle mass both
decrease as you get older. If
you're inactive, your muscles
weaken even more, which
increases your risk of fractures.
GENDER Women lose bone
density faster than men, owing
to the drop in oestrogen levels
during the menopause. This
accelerated bone loss increases
the risk of fractures. Men need to
be careful too, though, as they
can also develop dangerously
low levels of bone density.
Osteoporosis is the strongest
risk factor for a fracture. Other
conditions that can lead to
fragile bones include endocrine
disorders, such as overactive
thyroid, and intestinal disorders,
which may reduce vitamin D
and calcium absorption.
MEDICATIONS Taking cortisone
medication, such as prednisone,
can weaken bones over time.
Some drugs can cause dizziness,
increasing the risk of falling.
Too little calcium and vitamin
D in the diet when young
limits peak bone mass in later
life, increasing the risk of hip
fractures. Eating disorders, such
as anorexia, can also leave bones
vulnerable by depriving the body
of essential nutrients.
PHYSICAL INACTIVITY Weightbearing exercise, such as jogging
and walking, helps to strengthen
the bones and muscles, making
falls and fractures less likely.
TOBACCO AND ALCOHOL
These interfere with the
body's process of building and
remodelling bone tissue, resulting
in bone loss and weakness. Heavy
alcohol use, especially in youth,
can dramatically affect bone
health and increase the risk of
osteoporosis later in life.