A low-energy hip fracture in an older adult is a fragility fracture, and fragility fracture is itself an indication for osteoporosis treatment in major guidelines — a bone density scan is useful but should not delay a decision. The risk of a second fracture is highest in the first year or two.
Yet many patients leave the orthopaedic ward without bone protection or a plan for it. Making it part of the discharge checklist, or linking to a fracture liaison service where one exists, closes that gap.
- Check calcium, vitamin D, renal function and, where relevant, causes of secondary osteoporosis during the admission.
- Correct vitamin D deficiency and ensure adequate calcium intake.
- Start or arrange antiresorptive treatment before discharge, or document who will start it and when.
- Assess falls risk, vision, medications and home hazards as part of the same plan.
- Refer to a fracture liaison service or the GP with a clear written recommendation.
Why it matters
The second hip fracture is often more disabling than the first, and treatment after the first is commonly missed.
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