A hip fracture caused by cancer that has spread to the bone is a pathologic fracture, meaning the bone was weakened by disease before it broke with minimal or no trauma. While the diagnosis is serious, the condition is manageable. Care focuses on addressing the broken hip to relieve pain and restore function, and managing the underlying cancer that caused the bone weakness.
The Link Between Cancer and Bone Fractures
Cancer spreads from its primary site through metastasis, where tumor cells break away and travel through the bloodstream or lymphatic system to distant locations. Bone is one of the most common sites for metastatic disease, especially for cancers originating in the:
- Breast
- Prostate
- Lung
- Kidney
- Thyroid
Once in the bone, these cancer cells disrupt normal bone maintenance.
Healthy bone is in a constant state of remodeling, with osteoclasts breaking down old bone and osteoblasts building new bone. Cancer cells interfere with this balance. Some cancers create osteolytic lesions, which are holes that form when cancer cells accelerate bone breakdown, making it fragile.
Other cancers cause osteoblastic lesions, where new but structurally weak bone is formed. Lesions are often mixed, containing both osteolytic and osteoblastic components. This altered bone is significantly weaker than healthy bone, making it susceptible to breaking under the stress of everyday activities, resulting in a pathologic fracture. The proximal femur, the part of the thigh bone that forms the hip joint, is one of the most common locations for these fractures to occur.
Diagnosis and Initial Assessment
Before a fracture, a person might experience warning symptoms like persistent pain in the groin, thigh, or buttock that worsens with weight-bearing. This pain is often present at rest and may be severe enough to disrupt sleep. When a fracture is suspected, an X-ray of the hip is the initial diagnostic step.
An X-ray can confirm the break and reveal the underlying bone lesion. Physicians will order more advanced imaging to understand the tumor’s extent and surrounding bone quality. A computed tomography (CT) scan provides a detailed, cross-sectional view of the bone, while a magnetic resonance imaging (MRI) scan is particularly useful for visualizing the tumor’s size and its involvement with nearby soft tissues like muscles.
If the primary cancer is unknown, a biopsy is performed. A small sample of the tumor tissue is removed from the bone with a needle and examined by a pathologist. This analysis confirms the presence of cancer cells and helps identify their origin, which is a necessary step for planning systemic cancer treatment.
Surgical Treatment of the Fracture
The primary goals of surgery for a metastatic hip fracture are to alleviate pain, restore stability, and allow for a rapid return to mobility. The surgical approach is tailored to the individual, considering the fracture’s location, the extent of bone destruction, and the patient’s overall health and life expectancy. The objective is a durable fixation that allows the patient to bear weight almost immediately after the operation.
One common technique is an intramedullary nail, a metal rod inserted into the hollow center of the femur. It extends across the fracture to act as an internal splint and is secured with screws. This method provides strong fixation for fractures in the shaft or just below the ball of the hip joint.
For fractures in the femoral neck or head, or with extensive bone destruction, a hip replacement (arthroplasty) is a better option. In a partial hip replacement, the broken ball of the femur is replaced with a metal prosthesis. If the hip socket is also affected, a total hip replacement is performed, where both the ball and socket are replaced. Bone cement is often used to secure these components for immediate stability.
Managing the Underlying Cancer
Controlling the cancer that caused the fracture is a part of the management plan. This treatment runs parallel to surgical recovery and aims to slow tumor growth, reduce pain, and prevent future skeletal events. A multidisciplinary team, including an orthopedic surgeon and a medical oncologist, creates a comprehensive strategy.
Radiation therapy is frequently used after surgery once the incision has healed. It directs high-energy beams at the fracture site to destroy remaining cancer cells, controlling local tumor growth and providing pain relief.
Systemic therapies, which treat cancer throughout the body, are also deployed depending on the primary cancer. These can include:
- Chemotherapy, which uses drugs to kill fast-growing cancer cells.
- Hormone therapy for cancers like breast and prostate that are sensitive to hormones.
- Targeted therapy, which uses drugs that attack specific vulnerabilities in cancer cells.
- Immunotherapy, which harnesses the body’s own immune system to fight the cancer.
Bone-strengthening medications, such as bisphosphonates or denosumab, are also prescribed to slow bone destruction and reduce the risk of new fractures.
Recovery and Quality of Life
The period after surgery focuses on maximizing function and ensuring comfort. This process is guided by a team of healthcare professionals, including physical and occupational therapists and palliative care specialists. Physical therapy often begins within a day or two of the operation.
Physical therapy helps patients regain strength, balance, and the ability to walk safely. An occupational therapist assists with adapting daily activities and recommends equipment like walkers or raised toilet seats to enhance independence. Pain management remains a priority, using a combination of medications and other therapies.
For individuals with metastatic cancer, treatment goals are centered on maintaining the best possible quality of life. This involves managing symptoms, preserving mobility, and supporting emotional well-being. Setting realistic expectations with the healthcare team is an important part of this process, allowing the focus to remain on living as fully and comfortably as possible.