Preventing Hip Fractures Through Exercise

Most hip fractures follow a fall onto weakened bone. How strength, balance and home changes lower your risk, and when to see a doctor.

You can lower your risk of a hip fracture by doing two things together: keeping your bones and legs strong, and preventing falls. Exercise helps with both. A Cochrane review found that exercise reduced falls in community-dwelling older adults by about 23 percent, and a hip fracture almost always starts with a fall.

Why hip fractures matter

A hip fracture is a serious injury in later life. It usually needs surgery, a long rehabilitation period, and often leads to a loss of independence. Studies commonly report that roughly 15 to 30 percent of people die within a year, depending on age and other illnesses, and many survivors do not return to their earlier level of mobility. That is why prevention is worth far more than treatment.

Why they happen: a fall and a weak bone

A hip fracture needs two things to coincide: a fall, usually sideways, and bone that is too fragile to withstand it. That gives you two targets:

1. Make the bone stronger. See bone density and osteoporosis.
2. Make the fall less likely, or less harmful. Better balance, stronger legs, quicker reactions and a safer home.

Strengthening bone

Bone responds to load, so exercise that loads the hips and legs helps maintain it.

• Strength training two to three times a week, with heavier loads as you progress. See strength training for longevity and osteoporosis-safe loading.
• Weight-bearing activity such as brisk walking and stair climbing.
• Nutrition: enough protein (how much protein after 50), calcium (calcium for bone health) and vitamin D (vitamin D in Malaysia). Many Malaysians have low vitamin D despite the sun, because of indoor work and covered clothing, so ask your doctor about testing.

A Cochrane review in postmenopausal women found that exercise, especially combined programmes, produces small but worthwhile gains in bone density at the spine and hip. Do not expect exercise to replace osteoporosis medication where your doctor has prescribed it. This matters most after menopause, when bone loss speeds up. See exercise for menopause.

Preventing the fall

The Cochrane review of 59 trials found that balance and functional exercises, and programmes combining balance with strength training, reduced falls, and that programmes with a higher total dose, about three hours a week, did better. Tai chi may also reduce falls.

A weekly plan:

Progress by making balance harder (narrower stance, then less hand support) and adding load slowly.

Make the home safer

Many falls happen indoors. Check for these in a typical Malaysian home:

1. Wet bathroom tiles, so use non-slip mats and grab rails.
2. Polished tile floors, loose rugs and electrical cords.
3. Poor lighting at night between bedroom and toilet. Add night lights.
4. Steps and thresholds at doorways and between rooms.
5. Loose slippers, so wear fitted, non-slip shoes.

Ask your doctor to review medicines that cause drowsiness or low blood pressure, and have vision checked. See reducing fall risk at home. You can quickly check your risk with our fall risk check.

Who should prioritise this

Prioritise prevention if you are over 65, have osteoporosis or low bone density, have had a previous fracture or falls, have low muscle mass, or are a postmenopausal woman. If you are supporting a parent, see our page for adult children helping ageing parents.

Safety and when to see a doctor

• If you have osteoporosis, avoid loaded forward spinal bending, forceful twisting and high-impact jumping until your doctor or physiotherapist has reviewed your scan.
• See a doctor promptly if you have dizziness, fainting, repeated falls, or a new height loss or back pain, which can signal vertebral fractures.
• After any fall, seek urgent care for groin or hip pain, inability to put weight on the leg, or a shortened or rotated leg. This may be a fracture.

Bone density testing and treatment

Guidelines generally advise a DXA bone density scan for women from about 65 and men from about 70, and earlier if you have risk factors such as a previous fragility fracture, long-term steroid use, early menopause, low body weight, smoking or a family history of hip fracture. See DEXA scan and body composition in Malaysia. If you have osteoporosis, your doctor may prescribe medicines that reduce fracture risk, with calcium and vitamin D as needed. Exercise adds to this treatment and does not replace it. After any fracture from a minor fall, ask for a bone health assessment.

A 12-week starter plan

1. Weeks 1 to 4. Practise a single-leg stand beside the counter for 15 to 20 seconds each side daily, do sit-to-stands from a chair 2 sets of 8 on three days, and walk 15 to 20 minutes daily.
2. Weeks 5 to 8. Move to heel-to-toe walking, step-ups on the bottom stair, calf raises, and 25 to 30 minutes of walking.
3. Weeks 9 to 12. Add light dumbbells or a backpack to squats, extend single-leg stands to 30 seconds with less support, and add a weekly tai chi or balance class.

Measure progress with the sit-to-stand test and timed up and go test.

Key takeaways

• A hip fracture usually needs both a fall and weak bone, so prevention should target both.
• Exercise reduces falls by about a quarter in community-dwelling older adults, with the best results from balance plus strength training.
• Strength and weight-bearing exercise help maintain bone modestly. They do not replace osteoporosis treatment.
• Make your home safer and review medicines and vision.
• Get urgent help for hip or groin pain and inability to bear weight after a fall.

For a plan covering both bone and balance, we run home-visit assessments across KL and Selangor.