Fragility fractures and hip fracture care
Recognising fragility fractures, hip fracture types and their operations, the 2023 Hip Fracture Clinical Care Standard (surgery within 36 hours, nerve block, orthogeriatric care, weight bearing day 1), anticoagulants before surgery, delirium, and starting bone protection before discharge.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- A fragility fracture is one from a fall from standing height or less. After 50 it means osteoporosis until proven otherwise, and it doubles the risk of the next fracture, most of all in the first 2 years.
- Hip fracture is the most serious: about 1 in 4 patients die within 12 months, and only around half regain their previous mobility.
- The ACSQHC Hip Fracture Clinical Care Standard (2023) sets the bar: cognitive and pain assessment at presentation, a nerve block, surgery within 36 hours, orthogeriatric care, unrestricted weight bearing and mobilisation the day after surgery, a plan to prevent the next fracture, and a written discharge plan.
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Sources
- Hip Fracture Clinical Care StandardAU/NZAustralian Commission on Safety and Quality in Health Care, 2023
- Australian and New Zealand Guideline for Hip Fracture Care - Improving Outcomes in Hip Fracture Management of AdultsAU/NZAustralian and New Zealand Hip Fracture Registry Steering Group, 2014
- ANZHFR Annual ReportAU/NZAustralian and New Zealand Hip Fracture Registry, 2026
- Hip fracture: management (CG124)National Institute for Health and Care Excellence, 2011, updated 2023
- FDA adds Boxed Warning for increased risk of severe hypocalcemia in patients with advanced chronic kidney disease taking osteoporosis medicine Prolia (denosumab)US Food and Drug Administration, 2024
- Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial (Borges FK et al. Lancet 2020;395:698-708)Lancet, 2020
- Total hip arthroplasty or hemiarthroplasty for hip fracture (HEALTH) (Bhandari M et al. N Engl J Med 2019;381:2199-208)New England Journal of Medicine, 2019
- Liberal or restrictive transfusion in high-risk patients after hip surgery (FOCUS) (Carson JL et al. N Engl J Med 2011;365:2453-62)New England Journal of Medicine, 2011
- Spinal anesthesia or general anesthesia for hip surgery in older adults (REGAIN) (Neuman MD et al. N Engl J Med 2021;385:2025-35)New England Journal of Medicine, 2021
- Peripheral nerve blocks for hip fractures in adults (Guay J et al. Cochrane Database Syst Rev 2020;11:CD001159)Cochrane, 2020
- Zoledronic acid and clinical fractures and mortality after hip fracture (HORIZON Recurrent Fracture Trial) (Lyles KW et al. N Engl J Med 2007;357:1799-809)New England Journal of Medicine, 2007
- Effectiveness of non-operative versus operative treatment for frail institutionalised elderly patients with a proximal femoral fracture (FRAIL-HIP) (Loggers SAI et al. JAMA Surg 2022;157:424-34)JAMA Surgery, 2022
- Effect of surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus (PROFHER) (Rangan A et al. JAMA 2015;313:1037-47)JAMA, 2015
- Surgical plating vs closed reduction for fractures in the distal radius in older patients (CROSSFIRE) (Lawson A et al. JAMA Netw Open 2021;4:e2036802)JAMA Network Open, 2021
- Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR) (Clark W et al. Lancet 2016;388:1408-16)Lancet, 2016
- A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures (Buchbinder R et al. N Engl J Med 2009;361:557-68)New England Journal of Medicine, 2009
- Last updated
- 14 November 2026
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