Hip-fracture sufferers usually endure extreme pain, need surgery, and face permanent lifestyle changes. In the Spokane area, they also have lots of company.


Spokane Regional Health District figures show that the number of hip fractures here is 21 percent higher than the statewide average. Doctors say they cant pinpoint the reasons for the higher incidence of such fractures without more research, but they suspect Eastern Washingtons icy winter conditions and older-than-average population contribute to the problem here. Residents lack of exposure to sunshine, which provides calcium-absorbing vitamin D, also could be a factor, says one osteoporosis specialist.


We would need to slice and dice the data to truly determine the reason, but certainly one explanation could be simply that it is related to slipping and falling on ice and snow, says Dr. David Scott, an orthopedic surgeon here. Theres definitely less ice on the West Coast.


In 1999, the most recent year for which data were available, there were 940 hip fractures in Spokane for every 100,000 people, says health district spokeswoman Melanie Rose. The state average, 743 out of 100,000, was far lower. The number of hip fractures in Spokane County grew 7 percent overall between 1995 and 1999, Rose says.


Statistics from the Centers for Disease Control and Prevention (CDC), in Atlanta, show that most hip fractures occur in older persons after a simple fall at home. Osteoporosis, a disease that causes bones to become brittle, increases the risk of breaking a bone in a fall. People with severe osteoporosis can suffer broken bones by stepping off a curb, coughing, or being normally hugged by another person, says Dr. Lynn Kohlmeier, an endocrinologist with the Spokane Osteoporosis Center, at Deaconess Medical Center.


Fall protection is key, and bone density is tightly associated with the risk of hip fractures, Kohlmeier says.


Falls are the leading cause of injury deaths among people age 65 and older in the U.S., according to the CDC. It says that hip-fracture victims are hospitalized for an average of two weeks after suffering their injuries, and of all fractures from falls, hip fractures lead to the most severe health problems. Although death doesnt often occur from a hip fracture, sufferers of the injury are more prone to blood clots, pneumonia, and other potentially fatal complications and diseases, Scott says.


Long-term complications


Its a major health problem, partly because of the associated medical complications that go along with a hip fracture, Scott says.


At the very least, hip fractures can curtail ones independence and lifestyle, doctors say.


Although full recovery from a hip fracture is possible, its rare, Kohlmeier says. Someone whos suffered a bad fall might be less willing to leave the house and carry on an active lifestyle, she says.


Spokanes seasonally icy streets dont improve the situation, says Scott, who sees an increase in the number of patients with hip fractures during the winter. Scott and his two partners treat a total of about 100 hip fractures a year, he says.


We see a lot, Scott says. I know its not decreasing. I wouldnt be surprised if I were told the rate of hip fractures was increasing.


Scott says he doesnt think a widespread deficiency of calcium, which strengthens bones, exists here, nor does it seem to play a role in Spokanes higher rate of hip fractures.


I doubt its a diet thing, he says. Spokanes culture isnt so different from elsewhere in the state that eating habits here would have a profound impact on the fracture rate, he says.


Americans live longer today, and therefore the general population suffers more age-related health problems, Scott says.


The average age of the U.S. population is increasing dramatically, he says. That could be part of whats behind the increasing rate of hip fractures.


Plus, Spokanes population is older than the state average. In 2000, 12.4 percent of Spokane Countys population was age 65 or older, compared with 11.2 percent for all of Washington. In King County, 10.5 percent of the population is 65 or older. Scott says many of his patients retired here after living in Seattle most of their lives.


Kohlmeier says East Siders lack of exposure to sunshine during the long winters also could be contributing to the problem.


Theres a greater vitamin D deficiency in the Northwest because we have less sunshine, she says.


The Mayo Clinic, the prominent medical-research-and-hospital network based in Rochester, Minn., says natural sunlight helps the body produce vitamin D, which is critical to the development of healthy bones and teeth and helps prevent osteoporosis. It recommends getting at least 15 minutes of exposure to the sun three times a week.


Kohlmeier also speculates that an increasing number of patients who take medications for asthma and arthritis that contain steroids could be contributing to the higher rate of hip fractures here. Research shows that steroids reduce bones ability to absorb calcium, contributing to bone loss.


Although the CDC says one in every three Americans age 65 or older falls every year, hip fractures can be prevented by taking a few precautionary steps.


The single-most important thing is exercise, Scott says. Maintaining weight-bearing exercise, remaining active into the elder years, and making certain one takes the proper daily intake of calcium are important preventive steps.


He suggests taking a calcium supplement, such as Citracal.


Kohlmeier says some prescription medications, such as Fosamax and Actonel, can both prevent and treat osteoporosis by increasing bone density and making bones stronger.


The Osteoporosis Resource & Screening Center in the Deaconess Health and Education Center, 910 W. 5th, offers free bone-density tests on Mondays and Thursdays between 9 a.m. and 12 p.m. and between 3 p.m. and 5 p.m. Kohlmeier recommends that individuals over age 65 undergo the test, which is done by ultrasound on the bare heel. The test takes 1 minute and is noninvasive.


She also encourages patients to get information from Hospital Intervention Program in Spokane, or HIPS, which is a preventive education program she co-founded. Through HIPS and a take-home video called Better Bones and Balance, produced here at St. Lukes Rehabilitation Institute, patients can learn ways to strengthen their bodies and improve their balance to reduce the chance of falling. Kohlmeier says such programs are important because 20 percent of patients whove fractured their hips do so again within two years.


Both doctors say many elderly people recover from hip fractures or avoid them altogether.


Theres plenty of folks who go through a hip fracture and come out fine, Scott says. Just because youre 70 or 80 doesnt mean you cant be elderly and be healthy.