A global review restates what good fragility-fracture care looks like and where it falls short. The evidence base is strong and settled: timely surgery, orthogeriatric comanagement, early mobilisation, unrestricted weight-bearing and secondary fracture prevention all improve outcomes.
The shortfall is in delivery. International quality standards and registry audits have turned this evidence into measurable indicators in many high-income systems, but implementation in low- and middle-income countries is held back by workforce shortages, delayed presentation, limited infrastructure and fragmented pathways — not by any gap in the evidence. Emerging programmes show the standards can be adapted locally while keeping their core principles.
For the orthopaedic surgeon this is a prompt to lead rather than wait. Build the fracture pathway around prompt surgery and orthogeriatric input, mobilise and weight-bear early, and make sure every fragility fracture triggers bone-health assessment and secondary prevention — the step most often missed.
- Prioritise timely surgery and orthogeriatric comanagement for fragility fractures.
- Mobilise and allow unrestricted weight-bearing early after surgery.
- Make every fragility fracture trigger bone-health assessment and secondary prevention.
- The barrier in low-resource settings is health-system capacity, not lack of evidence.
- Adapt international quality standards locally while keeping their core principles.
Why it matters
The biggest gains in fragility-fracture outcomes now come from delivering known care reliably, not from new treatments, and surgeons are central to that.
Don't overread it
This is a perspective review consolidating existing evidence, not a new trial; it argues for implementation rather than reporting a new effect.
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