Bone Abstracts

Hip fracture is one of the most serious consequences of osteoporosis, yet in older adults it is rarely an isolated consequence of impaired bone health. Most patients presenting with hip fracture are also living with frailty, multimorbidity such as cognitive impairment, sarcopenia and functional decline. Consequently, outcomes following hip fracture are determined not only by fracture risk, but also by physiological reserve, recovery potential and the broader impact of geriatric syndromes. This presentation explores how frailty should influence osteoporosis management after hip fracture and argues that hip fractures should be viewed as frailty events as well as fragility fractures requiring bone-protective therapy. Drawing on the principles of Comprehensive Geriatric Assessment (CGA) and the Clinical Frailty Scale (CFS), it demonstrates how assessment of frailty, mobility, cognition, function, comorbidity, social circumstances and patient priorities can provide information that fracture risk tools alone cannot. While tools such as FRAX estimate fracture probability, CGA and frailty assessment help clinicians determine the most appropriate management strategy for the individual patient. Older adults with similar fracture risk may differ substantially in biological reserve, treatment burden, life expectancy and goals of care, requiring different approaches to investigation, treatment selection and follow-up. The complementary roles of orthogeriatric services and Fracture Liaison Services (FLS) in delivering integrated, person-centred secondary fracture prevention will be discussed, together with practical considerations for the use of antiresorptive and osteoanabolic therapies across the frailty spectrum. Integrating fracture risk assessment with frailty assessment and CGA provides a more holistic framework for clinical decision-making than fracture risk assessment alone. The goal is not simply to improve bone health, but to reduce future fractures, preserve independence, minimise treatment burden and deliver care aligned with the preferences and priorities of older adults.