Management of hip fracture in adults: summary of NICE guidance

Hip fracture resulting from a fall from standing height or lower in people with osteoporosis or osteopenia (fragility fracture) is a major, growing health problem associated with population ageing. It has an annual UK incidence of 70-75 000, with a medical and social care cost of about £2bn (€2. 3bn; 3. 3bn), 1 and one month and one year mortality of about 10% and 30% respectively2 (usually resulting from comorbidity rather than from the fracture itself). A comprehensive multidisciplinary approach, avoidance of delay, and continuity of management are needed from presentation to follow-up, including after transition from hospital back into the community. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of hip fracture. 3 The recommendations are for all adults but are based on surgical, anaesthetic, and orthogeriatric evidence and expertise acquired among older patients (the group in whom hip fracture is most common). Prevention of hip fracture is covered by other NICE guidance (on falls4 and osteoporosis5 6). NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Timing of surgery