Opportunities to improve bone protection following hip fracture in a regional health service — ASN Events
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Opportunities to improve bone protection following hip fracture in a regional health service (#383)

Abraham Shamshad 1 2 , James Cronin 3 , Francis Wong 4 , Annie Hung 1 3
  1. Endocrinology, Albury Wodonga Health, Albury, NSW, Australia
  2. Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  3. Rural School of Medicine, University of New South Wales, Albury, NSW, Australia
  4. Geriatric Medicine, Albury Wodonga Health, Albury, NSW, Australia

Hip fracture is a sentinel presentation of clinical osteoporosis. The Hip Fracture Clinical Care Standard recommends admitted patients receive bone protection medicine, or a prescription prior to separation (1). We audited pharmacotherapy provision after hip fracture at Albury Wodonga Health, a regional health service, and compared local practice with national registry benchmarks (2).

We retrospectively reviewed 148 hip fracture presentations during 2025. Data included demographics, admission source, premorbid function, cognition, residence, discharge destination, prior bone protection, bone protection at discharge, documented GP-directed treatment plans, and barriers to pharmacotherapy.

Our cohort had a mean age of 80.2 years and 63.5% were female. Prior to fracture, 10.1% were receiving antiresorptive therapy. After excluding inpatient deaths, 12.8% were discharged on active antiresorptive therapy. A further 41.9% had a documented plan for GP-directed initiation. Among patients with a documented treatment plan, 67.7% had a non-specific instruction for the GP to commence bone protection without a nominated agent, while 24.2% had a specific therapy documented and 8.1% were referred to endocrinology outpatients. Documented barriers to treatment were present in 33.1% of cases, most commonly dental issues, end-of-life care and vitamin D deficiency. Discharge pathways were heterogeneous, with 75.7% discharged to rehabilitation, another acute hospital or residential aged care.

In this regional hip fracture cohort, active bone protection at discharge was uncommon and appeared lower than the Australian ANZHFR benchmark of 35% (2). Non-specific GP-directed plans represent a key quality-improvement target. Given fracture liaison service models aim to improve post-fracture osteoporosis assessment, treatment initiation and adherence (3), and have been associated with reduced subsequent nonvertebral fracture incidence and mortality (4), a dedicated post-fracture osteoporosis follow-up pathway may reduce treatment ambiguity and missed secondary fracture prevention opportunities at care transitions.

  1. 1. Australian Commission on Safety and Quality in Health Care. Hip Fracture Clinical Care Standard. Sydney: ACSQHC; 2023.
  2. 2. Australian and New Zealand Hip Fracture Registry. Annual Report of Hip Fracture Care 2025. Sydney: ANZHFR; 2025.
  3. 3. Le HV, Van BW, Shahzad H, et al. Fracture liaison service—a multidisciplinary approach to osteoporosis management. Osteoporos Int. 2024;35:1719–1727.
  4. 4. Huntjens KMB, van Geel TACM, van den Bergh JPW, et al. Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am. 2014;96(4).