The good hip guide - how to protect yours

Hip fractures are increasing, yet there are things we can do to try to prevent them. Peta Bee looks at the diet and exercise tweaks to help your joints.

Yoga, pilates and regular stretching improves hip strength and flexibility.

Hip fractures account for about 75,000 hospital admissions a year in the UK, but a paper to be published next month in the journal Injury warns that this statistic will get worse.

Using data from the Royal College of Physicians National Hip Fracture Database, which tracks hip fractures occurring in England, Wales and Northern Ireland, experts from the University of Bristol’s Musculoskeletal Research Unit and the University of Southampton predict that by 2060, the number of hip fractures is projected to more than double.

“The older you get the bigger the risk of a hip fracture, and in our paper, which simply looked at the consequence of an ageing of the population, we found a tripling of risk in the oldest age groups, but an increased risk of hip fracture across all adult ages,” says Samuel Hawley, a research fellow in musculoskeletal epidemiology at the University of Bristol and one of the authors.

“But big drivers of fracture rates are diet and exercise and, while we have no control over our age, we do have control over these factors.”

This increase in fractures is particularly concerning in light of the news this week that more patients are being forced to raid their savings to pay for hip surgery. The Nuffield Trust told The Times that NHS waiting lists for hip replacements have increased exponentially; average waiting lists in England for a new hip were about 87 days before 2020, which roughly doubled to 180 that year, and have remained at about 128 days for the three years since the pandemic. No wonder the Health Foundation reports that the number of privately funded hip replacements has doubled since 2019.

The hip is a ball and socket joint at the top of your thigh bone where it meets your pelvis, and a break or fracture in this joint can be life-changing. Last year, a separate study carried out by the University of Bristol showed that hip fractures lead to decreased quality of life, increased emergency hospital readmission after discharge and raised risk of early death. “It’s a devastating injury that takes its toll in unexpected ways,” Hawley says. “And they become a much more serious risk from our sixties onwards.”

According to the Royal Osteoporosis Society (ROS), most hip fractures require surgery, with approximately two thirds of cases needing internal metalwork in the form of a sliding hip screw positioned at the neck of the femur to enable it to heal.

And while wear and tear of the hip joint that leads to osteoporosis accounted for a significant percentage of the 73,540 hip replacement operations carried out last year, surgery to replace a damaged hip joint with an artificial part is also needed after approximately 25 per cent of hip fractures.

“It’s never too early or too late to take action for protecting your hip bones,” says Jill Griffin, the head of clinical engagement services at the ROS. “Prevention of fractures is the key and there are many things we can do throughout life to keep our hip bones as strong and healthy as possible.”

Here’s how to protect your hips:

Coffee and high protein breakfasts can safeguard your body against hip issues.

- Drink 1-4 cups of tea and coffee a day

A high-caffeine diet increases the amount of calcium lost in urine which, in theory, could lead to a loss of bone strength and a greater susceptibility to fractures. However, tea and coffee also contain the biologically active plant compounds polyphenols and phytoestrogens, which seem to counteract the negative effects of caffeine.

Griffin says that some studies have shown that 1-4 cups of tea a day lowers the risk of thinning bones. Adding milk to your tea and coffee also provides some bone-building calcium. In a study of 26,318 middle-aged women published in Clinical Nutrition journal, food scientists at the University of Leeds found that every additional cup of tea or coffee was linked with a 4 per cent reduction in the risk of a hip fracture, although the ROS says four is a healthy upper limit.

“We still need to know more about how these drinks could affect bone health, but it might be through promoting the amount of calcium present in our bones,” says Professor Janet Cade, the lead author of the paper, who heads the Nutritional Epidemiology Group at Leeds.

- Eat 1 gram of protein for every kilogram of your body weight daily

Cade and her team also found that women who increased their protein intake by 25g a day had an average 14 per cent reduction in their risk of hip fracture in later life. Women who were underweight gained even greater protective benefits with a 25g daily increase in protein reducing their fracture risk by 45 per cent.

“Proteins are needed to keep cells, tissues and muscles working properly, but they also contribute to bone health,” says Rhiannon Lambert, a registered nutritionist and the author of The Science of Nutrition.

Healthy adults need about 1g of protein for each kilogram of their body weight every day. So, if you weigh 60kg, you need about 60g of protein. Cade stressed that “certain groups, such as vegetarians or vegans, need to check that their protein intakes are high enough for good health”.

In one of her previous studies in BMC Medicine she found that vegetarians had a 33 per cent higher risk of hip fracture than regular meat eaters. Three to four eggs, a steak or salmon fillet would provide about 25g of protein while 100g of tofu contains about 17g of protein. Other sources include yoghurt, cheese, beans, nuts and legumes. Very high intakes of protein - double or triple the recommended amount - are not recommended.

Getting a good night’s sleep regularly is crucial for bone strength.

- Aim for 7-8 hours sleep a night

Too little or too much sleep is not good for bone health. Genes that control our internal body clocks are present in our bone cells and release substances into the blood that act as important markers for bone turnover.

The process of bone resorption - the breaking down of bones - and bone formation follows a daily rhythm and any disruption to our circadian rhythm through lack of sleep might take its toll on bone health.

In a study at the University of Colorado, researchers found that three weeks’ sleep deprivation or disrupted sleep led to “significant detrimental changes in bone turnover in both men and women”. Another study of 11,084 postmenopausal women in the Journal of Bone and Mineral Research showed that those who slept for five hours or less each night had 22 per cent lower bone mass and 63 per cent higher risks of experiencing osteoporosis of the hip, a leading risk for fractures.

- Eat kale and prunes

Some evidence suggests that vitamin K, found in leafy green vegetables and prunes, plays an important role in bone health. According to the NHS, adults need approximately 1 microgram a day of vitamin K for each kilogram of their body weight, so someone weighing 60kg would need 60mcg a day.

However, an Australian study of 1,400 older women published in Food and Function found that those consuming 100mcg of vitamin K daily - equivalent to a large serving of dark leafy greens, or one-to-two servings of other vegetables - were 31 per cent less likely to be put in hospital by a hip fracture than those consuming less than 60mcg daily.

Prunes are another good source, but also contain phenolic compounds and dietary fibre known to enhance bone health. A review published in the American Journal of Clinical Nutrition found that eating 5-6 prunes every day for a year lowered the inflammatory chemicals that contribute to bone breakdown, helping women to preserve bone density in their hips.

- Drink alcohol only 2-3 days per week

Antony Johansen, an honorary professor and consultant orthogeriatrician at the University Hospital of Wales and the clinical lead for the National Hip Fracture Database at the Royal College of Physicians, says that too much alcohol is bad news for our hip bones. “In younger people, particularly men, a high alcohol intake is one of the commonest underlying risk factors for hip fractures,” Johansen says.

“Over time, too much alcohol will weaken the bones and also make you more susceptible to accidents and falls.” Aiming for under the upper limit of 14 units each week and drinking on no more than 2-3 days a week has been shown in studies not to impact bone mineral density adversely.

Limiting alcohol consumption ensures bone mineral density levels remain high.

- Consider a vitamin D supplement

It’s known to have heart-health benefits, but eating a Mediterranean-style diet could also protect your hip bones, according to a European-wide study of 1,294 people in their sixties and seventies that included teams from the University of East Anglia.

For 12 months, one group were encouraged to consume more nuts, olive oil, fish and vegetables. They were also asked to take a 10mcg supplement of vitamin D, the dosage recommended by UK government health officials in winter months, “to even out the effects of different levels of sunlight on vitamin D status between the participating countries”.

A control group read healthy eating leaflets and continued with their regular diet. Bone mineral density tests conducted before the study started had revealed that 10 per cent of participants already had osteoporosis and in these people the Mediterranean-style diet increased bone density in the hips. “We used to think of dairy and calcium as the main players in bone health,” Hawley says. “But we know that a more holistic approach to a healthy diet is important.”

- Load your hip bones with running, skipping and hopping

“People go to the gym to strengthen their muscles, but the good news is that a lot of strengthening and loading work also strengthens our bones, stimulating bone to repair itself,” Hawley says. Activities that involve working out against resistance, such as weight training, and high-impact weight-bearing exercises, such as jumping, skipping or hopping and running, are essential for maintaining healthy bones because they provide forces that pull down on the skeleton to strengthen it.

“Studies have shown that the bone mineral density of the femoral neck of the hip is highly responsive to mechanical loading with activities such as running very beneficial for strengthening it,” says Dr Nicky Keay, an honorary clinical lecturer in medicine at University College and the author of Hormones, Health and Human Potential.

Swimming and cycling, in which the body is supported by water and bike respectively, are not the best bone builders. “If these are your preferred activities, then do some supplementary multi-directional hopping, skipping and body-weight exercises for 15 minutes three times a week to build hip bone strength,” Keay says.

- If you fracture a wrist, your hips are at risk

“Half of those people who suffer a hip fracture have already experienced a fracture somewhere else,” Johansen says. If you are one of them, then it is a red flag warning that you are in the high-risk category for a hip fracture.

Half of NHS trusts in England and Wales offer a Fracture Liaison Service (FLS), which plays an important role in identifying, assessing and treating osteoporosis in people over the age of 50 with a fracture.

Ask your GP or consultant whether there is an FLS at your local hospital or doctor’s surgery, but even if there isn’t you should push for a referral, Johansen says. “By catching people with a high fragility fracture risk early enough, we can offer treatments that will prevent hip fractures,” he says. “These include bisphosphonates, taken as a weekly pill to slow bone loss, or injections or infusions of longer-lasting drugs that are highly effective.”

THE TIMES