Hip Fracture Prevention in Canada: Protecting the Bones That Matter Most

A hip fracture in an older Canadian isn't just a broken bone. It often marks a turning point in independence, health, and longevity. The good news: most hip fractures are preventable, and the strategies that work are accessible to nearly everyone.

The Canadian Hip Fracture Reality

30,000+

Hip fractures in Canada each year (Osteoporosis Canada)

20–30%

Of older adults who suffer a hip fracture die within one year

50%

Never regain their prior level of independence and mobility

Hip fractures are almost always the result of two converging factors: low bone density (osteoporosis) and a fall. Address both, and fracture risk drops dramatically. Most hip fractures happen from sideways falls — specifically, falling directly onto the greater trochanter (the bony prominence on the outer hip). The mechanics of the fall matter as much as bone density.

Canada's aging population means hip fracture rates are expected to increase significantly over the next two decades. The healthcare system cost is estimated at over $2 billion CAD annually. But hip fractures aren't an inevitable consequence of aging — they're largely preventable with systematic attention to fall risk and bone health.

Understanding Your Fall Risk

Falls in older adults are rarely random accidents. They're typically the result of identifiable, modifiable risk factors stacking up. Understanding which apply to you or a family member is the starting point for prevention.

Intrinsic (person-level) risk factors

Muscle weakness — particularly hip and knee extensor weakness; the single strongest modifiable predictor of fall risk
Balance impairment — declining proprioception, vestibular function, and reactive balance with age
Gait abnormalities — shuffling gait, reduced step length, wider stance
Visual impairment — uncorrected vision, cataracts, macular degeneration; visual input is critical for balance
Cognitive impairment — reduced attention to environmental hazards
Orthostatic hypotension — blood pressure drop on standing that causes dizziness
Neuropathy — reduced foot sensation from diabetes or other causes
Prior falls — the single strongest predictor of future falls

Medication-related risk factors

This is one of the most underappreciated contributors to falls in older Canadians. Several classes of medications significantly increase fall risk:

Sedatives, sleep aids, and benzodiazepines (Ativan, Xanax, Restoril, zopiclone) — among the highest-risk medications for falls; daytime sedation and impaired balance persist beyond the night dose
Antidepressants — particularly tricyclics (amitriptyline) and SSRIs can cause orthostatic hypotension and impaired balance
Antipsychotics — significant fall and fracture risk, particularly in older adults
Blood pressure medications — overly aggressive blood pressure control can cause dizziness on standing
Antihistamines — older antihistamines (diphenhydramine/Benadryl) are strongly sedating and fall-promoting in older adults; this includes sleep aids containing diphenhydramine
Diuretics — can cause dehydration and electrolyte imbalances that affect balance

A medication review by your doctor or pharmacist — specifically looking for fall risk — is one of the highest-yield fall prevention interventions available. The STOPP/START criteria and the Beers Criteria list specific medications that are inappropriate for older adults. Ask your doctor to review your complete medication list with fall risk in mind.

Home Safety Checklist

Most falls in older adults happen at home — and most home fall hazards are fixable in an afternoon. Work through this checklist:

Bathroom (highest-risk room)

☐ Grab bar beside toilet (not just a towel bar — grab bars are rated for body weight)
☐ Grab bar in shower or bath
☐ Non-slip mat inside shower/bath and on bathroom floor
☐ Bath bench or shower chair if standing balance is uncertain
☐ Raised toilet seat if standing from standard height is difficult

Stairs and entries

☐ Sturdy handrail on both sides of stairs if possible
☐ Non-slip treads on stairs
☐ Good lighting on stairways; light switches at both top and bottom
☐ No clutter on stairs

Throughout the home

☐ Remove or secure all area rugs (they're a leading fall cause); use non-slip backing if keeping rugs
☐ Clear pathways — furniture arranged with wide walking paths
☐ Extension cords secured against walls; not crossing walkways
☐ Nightlights in hallway, bathroom, and bedroom for night-time trips
☐ Commonly needed items at accessible heights — not requiring reaching overhead or bending low

Footwear

☐ Shoes with non-slip soles and firm heel support worn even indoors
☐ No walking in socks on hardwood or tile floors
☐ Replace worn-down shoe soles promptly

Balance Exercises for Hip Fracture Prevention

Balance is trainable at any age. These exercises, done regularly, improve the reactive balance and proprioception that prevents a stumble from becoming a fall:

Single-leg standing

Stand on one foot, near a countertop for safety. Hold for 10–30 seconds, then switch. Progress by closing your eyes (significantly harder) or standing on a folded towel or balance pad. Do this while brushing your teeth to build it into your day.

Heel-to-toe (tandem) walking

Walk in a straight line placing the heel of one foot directly in front of the toe of the other. Ten steps forward and back. This challenges the narrow base of support that balance recovery requires.

Sit-to-stand practice

Rising from a chair without using your hands is one of the strongest predictors of functional mobility. Practice getting up from progressively lower chairs. This builds hip and knee extensor strength — the same muscles that catch you when you stumble.

Tai Chi

Multiple large trials confirm Tai Chi reduces fall rates by 20–45% in older adults. It improves proprioception, builds slow controlled movement, and increases confidence. Classes are available through recreation centres across Canada, and YouTube has many free beginner programs. Thirty minutes, three times per week is the typical studied dose.

Hip Protectors

Hip protectors are padded garments or inserts worn over the hip area to absorb impact from sideways falls. They work physically by shunting force away from the greater trochanter to surrounding soft tissue. Evidence for their effectiveness in preventing hip fractures is moderate — a Cochrane review found significant reduction in hip fractures among nursing home residents who wore them consistently. The challenge is consistent use: many people find them uncomfortable or won't wear them reliably.

For individuals with high fall risk and significant osteoporosis (particularly those in care facilities or with a prior hip fracture), hip protectors are a reasonable addition to other strategies. Brands available in Canada include HipSaver and TYTEX; prices range from approximately $60–120 CAD.

After a Hip Fracture: Recovery and Next Steps

If a hip fracture has already occurred, the most important things to know:

Most hip fractures require surgery (internal fixation or hip replacement, depending on fracture type) — usually within 24–48 hours for best outcomes
Post-fracture physiotherapy is essential and covered through the hospital and typically post-acute care
A hip fracture is a strong signal that osteoporosis treatment should be started or intensified — yet research consistently shows that fracture liaison services in Canadian hospitals remain underutilized; push your care team for a bone health review post-fracture
The year following a hip fracture carries the highest re-fracture risk — fall prevention interventions should be implemented before discharge

Medical Disclaimer: This article is for educational purposes only. Fall prevention and hip fracture prevention should be addressed with your healthcare team, particularly if you have a prior fracture or established osteoporosis. Individual circumstances affect which interventions are most appropriate.