For older adults and their families, few injuries carry higher stakes than a hip fracture — yet the gap between best available evidence and routine clinical practice remains surprisingly wide. A comprehensive narrative review published in JAMA consolidates current knowledge on one of medicine's most consequential musculoskeletal events, synthesizing findings across diagnosis, surgical management, rehabilitation, and long-term prevention in an aging global population.
The review highlights that hip fractures disproportionately affect adults over 65, with one-year mortality rates ranging from 14% to 58% depending on patient frailty, comorbidity burden, and time-to-surgery. Fragility fractures of the femoral neck and intertrochanteric region each carry distinct biomechanical profiles that influence surgical choice — internal fixation versus arthroplasty — with emerging evidence favoring total hip replacement over hemiarthroplasty in functionally active patients with displaced femoral neck fractures. Multidisciplinary orthogeriatric co-management models are consistently linked to reduced complications and shorter hospital stays. On the prevention side, the review synthesizes data on fall-risk modification, bone mineral density screening, bisphosphonate adherence, and the underappreciated role of vitamin D and calcium status, noting persistent undertreatment of osteoporosis following index fracture events.
This review is clinically valuable precisely because hip fracture remains a sentinel event where secondary prevention frequently fails: studies consistently show that fewer than 25% of patients receive osteoporosis pharmacotherapy after a fragility fracture, representing a major systems-level gap. The narrative format, while comprehensive, limits causal inference — this is a synthesis of heterogeneous evidence, not a meta-analysis with pooled effect sizes. For health-conscious adults, the practical implication is that bone health optimization and fall prevention are modifiable levers decades before fracture risk peaks. This is confirmatory rather than paradigm-shifting science, but its clinical consolidation in a high-impact journal signals renewed urgency around a preventable public health burden.