Dr. Alan Whitfield

A hip can break before you fall: the six stages a surgeon sees

A hip can break while a woman is still standing up. Not when she hits the floor. Before. The bone gives during an ordinary step or turn, and the fall comes second. If you're over 55 and you've ever gone down without knowing what you tripped on, or you've lost height, or you've broken a wrist falling from standing, read this to the end. I'm Dr. Alan Whitfield. I'm 58, and I've been an orthopedic trauma surgeon for 26 years. I've operated on more than 4,000 broken hips. I still take the 2am calls, and I train the residents who will take them after me. I need to tell you something a 15-minute appointment never leaves time for, because for most of my career I didn't say it either. Families tell me the fall broke the hip. For a lot of my patients, it happened the other way round. The hip broke, and then she fell. A hip that breaks before the fall doesn't come out of nowhere. It goes through stages. I count six. Most women only ever see the last two. By the time they see stage six, they're on the floor. Stage one. The quiet years. Long before anything breaks, the bone changes, and you can't feel it happening. Bone is living tissue. Your body takes down old bone and builds new bone every day, and most of the adult skeleton is replaced about every 10 years. It's rebuilt out of what you eat. So think about what the plate looks like at 60 for a lot of women. Toast and coffee. A yogurt cup at lunch. Half a chicken breast at dinner, if anybody's cooking. If you're on a weekly weight-loss shot, maybe less than that, because you're not hungry, and that's the point of the shot. Eating less means less room for the nutrients food used to supply. The skeleton keeps rebuilding with whatever arrives. Nothing hurts. Your scan, if you've had one, comes back "a little thin." Somebody tells you to keep up the calcium. You keep it up. That's stage one. Stage two. The small breaks nobody counts. A wrist that breaks when you catch yourself on a wet step. A toe on the bed frame that never quite stops aching. A bone in the top of your foot that cracks when you miss the last stair. Everyone calls it bad luck. The ER puts on a splint. Somebody types the words "fall from standing" into the chart, and nobody stops to ask what they mean. They mean the bone broke in a fall that a 30-year-old would get up from and laugh about. Ida Ostrander's rib, at the airport, was one of those. That's stage two. Stage three. The inch. Your driver's license says one height. A nurse measures you and gets another, and says, "We all shrink a little." Sometimes that inch is posture. Sometimes it's a vertebra in your back that has quietly collapsed, and nobody knew, because a spine bone can give with no fall at all. Rosalind Pike had three of those in her back before her hip ever broke. She found out from the X-ray I ordered for surgery. The inch is a break you didn't feel. That's stage three. Stage four. The ache. This is the one I wish more women would tell somebody about. When I ask, some of my hip patients say the hip or the groin had been sore for a week or two before it broke. A dull ache when they turned over in bed. A catch when they pivoted at the stove. They put a heating pad on it and took 2 of whatever was in the medicine cabinet. Not every hip gives a warning. But when a woman over 55 has new hip or groin pain and no fall to explain it, that's worth a phone call to her doctor, and worth asking whether it needs an X-ray. Almost none of mine made that call. That's stage four. Stage five. The turn. Then one ordinary day the bone meets one ordinary load it can't carry. Not a ladder. Not ice. A step off a curb. A turn at the sink. A pivot toward a voice in the next room. Standing up from a pew. The narrow neck of the thigh bone, just below the ball of the hip, gives way. Often the woman feels it. Some of them hear it. "Like a stick snapping under a rug," one of them told me. Then the leg won't hold her, and she goes down. My mother's hip broke that way in February 2017. She was 79, up on her toes in her kitchen, reaching for a casserole dish over the refrigerator. Her hip broke. Then she fell. Dolores Haney's hip broke when she turned in her hallway in 2004. Karen's broke when she stepped off the curb outside her bank in April 2025. Inga Falk's broke when she stood up from a church pew and turned to shake a hand. Every one of them was standing up. Every one of their families said, "She fell." That's stage five. Stage six. The floor. Stage six is everything after the break, and it's where I meet them. Elsie Fennimore was 66 in November 2019. She ran a lathe in the machine shop at the pump plant for 33 years, and she could still feel a thousandth of an inch with her thumbnail. Widowed 5 years. Five mornings a week she drove a Meals on Wheels route and carried every cooler bag up every porch step herself. She took a calcium with D every morning for 14 years, with her oatmeal. At 61 her scan said osteopenia. Her doctor told her to keep up the calcium and stay active. She did both, every single day, the way she'd once held a part to a thousandth. On a Tuesday night that November, at 3:20 in the morning, she got up to use the bathroom. Her bedroom door has a little wooden threshold strip, maybe half an inch high. She had stepped over it every night for 31 years. She stepped down off it onto the hallway runner, and her left hip broke. "I felt it go before I went down," she told me in the ER. "Doctor, I didn't trip. I just stepped." Then she was on her side on the runner in her nightgown, and the leg wouldn't move. Her phone was on the nightstand. 9 feet behind her. She dragged herself back toward it on one elbow. She called out the whole time. Nobody heard. It took her 1 hour and 40 minutes to cover 9 feet, and the runner rubbed the skin raw on her outer thigh the whole way. By the time she reached the charger cord and pulled the phone down onto the floor, the bruise ran from her hip to just above her knee. She called 911 at 5:02. I repaired her hip that morning. When the first screw went in, I felt it through the handle. It turned, and turned, and never caught. I went up a size and added a plate. In the operative note I wrote the two words I've written more times than I can count. Poor purchase. She spent 6 weeks in rehab and went home with a walker. She gave up her Meals on Wheels route, because she couldn't carry a bag up a porch step anymore. She sold the house with the threshold strip in 2020 and moved into a one-floor duplex across the street from her sister. At her 6-week visit she asked me something I didn't have an answer for. "I did everything I was told. Every pill. Every morning. What should I have asked?" I told her to keep up the calcium. That's stage six. Since 2004 I've kept a black notebook in the bottom drawer of my desk at the hospital. One line for every patient over 50 I operate on after a minor fall or strain. Nobody at the hospital knows it's there. I'm on my second notebook. It has 1,140 names in it. Last spring, with Elsie's question still in my head after 6 years, I went back through the charts of the hip patients in that second notebook. I read the first thing each woman said in the ER. Not the triage note. Her own words, the ones a nurse writes down in quotation marks. 173 of them said some version of what Elsie said. "I felt it go." "It just gave." "I didn't trip." "I was only turning around." 173 women whose hips broke while they were standing up, and whose families told everyone they fell. Nobody asked. And here's the part I'm ashamed of. The last column of my notebook is what she'd been told to do. On almost every one of those 173 lines, it says the same word. Calcium. So what does it mean when a hip breaks first? It means the bone failed under a load it was built to carry. A step. A turn. Her own weight. That points at the bone, and the bone took years to get that way. Here's what most people are never told about bone. Most people think bone is calcium. It isn't. Bone is a frame with mineral laid down on it. The frame is collagen. Collagen is about 90% of bone's organic framework, and it's the main structural protein of bone, tendons, ligaments and skin. Calcium, magnesium and other minerals are laid down on that frame. About 60% of the body's magnesium is in bone. Mineral without a frame is brittle. A frame without mineral is soft. Bone needs both. In surgery I feel the difference through the handle of the instrument. Good bone fights the drill. Bad bone lets the screw spin. That's what "poor purchase" means. The screw has nothing to bite. Elsie's bone had 14 years of calcium in it. It didn't have much to hold onto. There's more to the list than the frame and the calcium. Calcium needs vitamin D to get in. Without enough D you absorb only a small fraction of the calcium you eat. Vitamin K2, the MK-7 form, activates osteocalcin, a protein that helps bind calcium into bone. Vitamin C is needed to form collagen. Copper is needed to cross-link the collagen fibers. Calcium is one item on that list. The muscle around the hip matters too. If you've lost weight this year, especially fast, know that weight loss can include lean tissue as well as fat. Some of what came off may be muscle that used to steady you on a turn. For 26 years, the standard advice for all of this was one word. I gave it myself. I gave it to my own mother at her kitchen sink in my second year of residency, without looking up from the dishes. "Calcium, Mom." One word for half the job. I want to be fair to the women in my notebook. They weren't careless. Almost every one of them was doing something, and I've seen every version of it. Calcium alone. Elsie, 14 years, every morning with her oatmeal. It feeds the mineral. It does nothing for the frame. Double the calcium. Karen doubled hers on a friend's advice while she was losing weight on a weekly shot. Twice the mineral. Still no frame. The pink tub. A beauty-aisle collagen powder on the bathroom counter, a scoop on Sundays when she remembered. Built for skin. No calcium, no D, no K2. The gummy. 2 orange chews a day from the warehouse store. A candy with a little calcium in it. 5 bottles on the windowsill. Calcium, D, magnesium, a joint pill with a knee on the label, something for her eyes. Most of the women I meet with 5 bottles are down to 2 by the second month. "I'll just eat better." Toast. Tea. Half a can of soup. My own wife made it to Thursday with the bottles I bought her this May. Everything right. Every one of them did what she'd been told. She'd only been told one word. My scrub nurse, Gloria, is 58. She's handed me instruments on hip cases for 11 years, and she's felt more screws spin than most surgeons. She was across the table in 2017 when I operated on my mother. One morning last spring, at the scrub sink at 6:40, I told her about the 173. I read her a few of the lines off a sheet I'd folded into my scrub pocket. "I felt it go." "It just gave." She scrubbed for a while without saying anything. Then she held her wet hands up and leaned over to read the sheet against my arm. "Doc, I've heard 'it just gave' across this table a hundred times and never once thought about my own hips. I do now. I look after mine before I'm out of the car in the morning." She has stirred the same thing into her coffee every morning since the fall of 2024, after her sister broke her wrist. She gardens on her knees every weekend with no pad and gets up without a hand on anything. It's called DensiaPlus. After the case she brought the bag up from her locker, and I read the back the way I read a chart. 9 grams of collagen peptides, for the frame. Collagen peptides supply glycine, proline and hydroxyproline. Studies on collagen peptides commonly use 2.5 to 15 grams a day. Calcium, 660 milligrams, as citrate. Calcium helps build and maintain strong bones. Magnesium, 198 milligrams. Vitamin D3, 1,320 IU, because calcium needs D to get in. Vitamin K2 as MK-7, 132 micrograms, for osteocalcin. Vitamin C, 132 milligrams, for forming collagen. Copper, for cross-linking it. Zinc and boron. Unflavored. One 10-gram scoop. It disappears into coffee, tea or water. Here's what it isn't. It isn't a prescription, and it doesn't replace one. Collagen isn't a complete protein, so it doesn't replace a plate of eggs or chicken. It goes with it. And I won't tell you what it will do to anyone's next scan. Nobody can promise you a scan. I've put a scoop in my own coffee every morning since last spring, before I drive in. My wife, Diane, has run a flower shop for 20 years and carries a 40-pound bucket of water and roses on each hip. She's had it in her first coffee every morning since June. The bottles went in the trash. That's my kitchen. Yours is your call, and your doctor's. Something else changed in the ER. Since this summer, when a woman over 55 comes in with a broken hip, I read the nurse's quote at the top of her ER chart before anything else. If it says some version of "I felt it go," I copy it word for word onto her line in the notebook. 52 hip patients over 55 since the start of summer. 14 of their lines have it. The hip is already broken by then. But the next time somebody asks what happened to her, it's written down in her own words. Elsie's line in that notebook says "fall at home." I never wrote down what she told me. What I tell women now is a list of questions. Elsie asked me what she should have asked. It took me 6 years to answer her. These are the questions I'd take to your next appointment, written down, so the 15 minutes don't run out first. 1. "Will you measure my height today and compare it to my license?" If it's down an inch or more, ask what that could mean. 2. "I broke a bone in a fall from standing height. Does that change anything for me?" Ask it even if it was years ago. 3. "Should I have a bone density scan? If I've had one, what did it say, and when is the next one?" Write down the word they use. 4. "My hip or groin aches when I turn, and I didn't fall. Should that be X-rayed?" Say the words "I didn't fall" out loud. They change what your doctor looks for. 5. "I've lost weight this year. How do I keep my protein and my muscle up while I do?" If you're on a shot, your doctor runs it. Ask anyway. 6. "Is calcium all I need, or is my plate missing the rest?" 7. "Is it safe for me to lift something twice a week?" Then, at home. Eat protein first. Eggs before toast. Chicken before rice. Lift or carry something on purpose, if your doctor agrees. Practice getting down onto the floor and back up, beside a sturdy chair, every night. Keep your phone in your pocket. At 3:20 in the morning too. On the way to the bathroom too. Elsie does all of it now. She eats 2 eggs before her oatmeal. She practices getting up off her living room carpet beside a dining chair, with her physical therapist's handout taped to the wall. Her phone sleeps in the pocket of her robe. In September she wrote the 7 questions on an index card and gave it to her sister. I don't know what either of their next scans will say. They both do the list. If you've broken a bone in a fall from standing height and somebody called it bad luck. If you've had a nurse write down a height shorter than the one on your license. If you feel an ache in your hip or groin when you turn, and you've put a heating pad on it instead of making a phone call. If you've taken the same calcium for 10 years and nobody has asked what else you eat. If you've lost a lot of weight this year and breakfast is black coffee. If you leave your phone on the nightstand at night. Write the 7 questions down tonight and take them to your next appointment. Ask before stage six. Count what you keep. DensiaPlus is 9 grams of collagen peptides with calcium, magnesium, vitamin D3, vitamin K2 (MK-7), vitamin C, zinc, copper and boron. One scoop a day, stirred into coffee, tea or water. It's the Fall Sale. Right now it's up to 70% off: buy 2 bags, get 1 free, or buy 3, get 2 free. Every bag comes with a 90-day money-back guarantee, empty or full. Dr. Alan Whitfield, 58, orthopedic trauma surgeon P.S. If you take a blood thinner like warfarin, talk to your doctor before starting anything with vitamin K, this included. Calcium can affect how some medications are absorbed, so ask your doctor or pharmacist about timing. Keep taking everything you've been prescribed. P.P.S. Elsie Fennimore stepped down half an inch off her bedroom threshold at 3:20 in the morning, and her hip broke before she reached the runner. It took her 1 hour and 40 minutes to get to a phone 9 feet away. Her phone sleeps in her robe pocket now. P.P.P.S. Up to 70% off: buy 2, get 1 free, or buy 3, get 2 free. 90-day money-back guarantee, empty or full.