Musculoskeletal conditions account for more than 40 million disability-adjusted life years a year in people aged 60 and over, and up to half of older adults have multimorbidity that needs optimising for a good surgical result. This JBJS perspective argues that the orthopaedic contact - increasingly common as arthroplasty rates rise - is an under-used opportunity to change what happens after the surgical episode.
It frames the argument around the World Health Organization's concept of intrinsic capacity, the physical, mental and psychosocial reserves a person draws on, across five domains: locomotion, vitality, cognition, sensory function and psychological well-being. Two of those are squarely orthopaedic territory - locomotion, meaning neuromuscular function, and vitality, meaning skeletal muscle mass, bone health and the metabolic and nutritional factors behind them.
The three interventions proposed are deliberately unglamorous. Give a written prescription for muscle strengthening and balance training, rather than advice to stay active. Screen for malnutrition and reinforce what adequate protein and micronutrient intake looks like. And take the lead on bone health optimisation rather than assuming someone else has. Each takes minutes, none needs a new service, and the third in particular addresses a gap that is well documented everywhere - the patient who has a fragility fracture fixed impeccably and leaves without anything being done about the osteoporosis that caused it. In settings where dietary protein intake is low and vitamin D deficiency common, the malnutrition step is not a formality.
- Write the strengthening and balance programme as a prescription, with frequency and duration, not as advice.
- Screen for malnutrition explicitly - a validated tool takes minutes and identifies patients whose surgery will go worse.
- Own the bone health decision: assess fracture risk, check what needs checking, and start or refer for treatment.
- Ask the fracture liaison question in every fragility fracture: who is treating the osteoporosis, and by when?
- This is a perspective article, not trial evidence - the interventions are supported elsewhere, and the contribution here is the framing and the prompt.
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