Broken bones from falls while dog walking are on the rise among older U.S. adults and hip fractures are among the most common injuries.

That’s according to a study published Wednesday in JAMA Surgery.

University of Pennsylvania researchers examined government data on emergency room visits for dog walking injuries in adults aged 65 and older. The numbers nationwide jumped from almost 1,700 in 2004 to about 4,400 in 2017.

Almost 80 percent of the patients were women, who tend to have less dense bones than men.

While dog-walking causes fewer than 1 percent of fractures among older adults, the numbers are higher than expected and the risk is often underappreciated, said study co-author Dr. Jaimo Ahn, an orthopedic surgeon.

Injuries typically happen when a dog pulls on a leash and walkers lose their balance.

Breaking bones, especially hips, can sharply diminish elderly adults’ health. Previous research suggests that at least 1 in 4 older adults dies within one year of breaking a hip.

But research shows that dogs can be good companions for older adults and can help them stay active. So before embarking on those outings, older people should consider strength training for themselves and obedience training for their dogs, Ahn said.

Susan Bush, 69, has had several injuries from falls while walking her dogs. The worst happened three years ago, while putting her leashed shepherd mix, Piper, on the porch of her Pocono Pines, Pennsylvania cottage just as a bear came out of the woods.