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Hip fracture report highlights need to prevent secondary fractures 

Treatment | Osteoporosis Management

16 Dec 2019

According to new data released by the National Hip Fracture Database (NHFD) today, 66,313 people presented with a hip fracture at one of the 175 trauma units across England, Wales and Northern Ireland in 2018.

The latest figures show a progressive improvement in mortality in the month after hip fracture, with 564 fewer people dying within a month of breaking their hip compared to 2017.

Overall, the number of deaths following hip fracture has halved to 4,007 people a year since 2007, when the NHFD was established by the British Orthopaedic Association (BOA) and the British Geriatric Society (BGS) to facilitate improvements.

However, the report also highlights a worrying decline in the use of bone protection medication. 

Just 8.2% of people admitted for a hip fracture were already on treatment to reduce the risk of further fracture and one in four people (24.7%) were not prescribed anything to protect their bones.

Alison Doyle, head of operations and clinical practice at the Royal Osteoporosis Society, which helped to establish the NHFD, says, "While the reduction in mortality rate is to be welcomed, this year’s data shows hip fractures continue to have poor outcomes.

"Many individuals never make it back to their own home and end up going into care, which has a significant impact on the individual, NHS and social care system.”

She adds, “12% of people who have a hip fracture will go on to fracture their other hip within the same year, so it’s worrying that this year’s report shows a decline in the use of bone protection medication.

"More work needs to be done to ensure that anyone over the age of 50 who experiences any kind of fracture is directed towards a Fracture Liaison Service and put on a treatment pathway to reduce the risk of them ever experiencing a hip fracture.”

This year’s data also shows that over a quarter of patients are undergoing an operation that is not the one recommended by the National Institute for Health and Care Excellence (NICE).

This means more work needs to be done to embed standardised, evidence-based decision-making around surgical implant choices. Clinical leads in hospitals are being called on to review current surgical practice and their implant inventories to ensure consistency across consultant-led teams.

More work also needs to be done to create greater consistency across different countries. While trusts in England have seen their key performance indicators for achieving prompt orthogeriatric review following a hip fracture increase to 93%, and trusts in Northern Ireland have seen this increase to 87%, Wales lags behind with an NHFD performance rating of just 58%.

“There remains huge variation in how likely a patient presenting with a hip fracture is to receive admission assessment by an orthogeriatrician,” says Julia Ellis, chair of the Royal Osteoporosis Society’s patient and carer panel.

She adds, “Best practice in treating and preventing hip fractures isn’t equal across the country and while most trusts are taking steps forward, four units in Wales still have no orthogeriatric service. There’s still a lot to do to ensure everyone receives best care and the Royal Osteoporosis Society is working to put this issue under the spotlight in Wales in particular.”

Read the NHFD report