Hip fracture care shaped by where you live, latest national audit report finds

A patient's chances of surviving a hip fracture can depend more on the hospital where they are treated than their age, sex, ethnicity or socioeconomic background, according to a new National Hip Fracture Database (NHFD) report. It also highlights a need for more universal provision of care to be provided by fracture liaison services, calling on hospitals and other parts of the healthcare system to work more closely together to prevent secondary hip fractures.

Each year, more than 72,000 people are treated in hospital for a hip fracture in England, Wales, Jersey and Northern Ireland. These patients occupy around one in 30 hospital beds, costing the NHS an estimated £1.1 billion annually, and social care a further £1.25 billion in the first 120 days after injury.

The new NHFD report sets out several key findings:

Thousands of hip fractures could potentially be prevented: Around a quarter of patients admitted with a hip fracture each year have previously suffered a fragility fracture, yet many were not receiving treatment to strengthen their bones and reduce the risk of further fractures. Nearly half of NHS trusts in England do not have a Fracture Liaison Service.

People living in more deprived areas face a higher risk of hip fracture: Men in the least deprived communities are around half as likely to experience a hip fracture as those in the most deprived communities. The report states that more than 8,500 hip fractures among men could be avoided each year if this inequality in risk were reduced.

Previous work using NHFD data showed that ethnicity was not associated with significant differences in adjusted outcomes, although patients from ethnic minority backgrounds were less likely to be mobilised on the day after surgery, highlighting the importance of accessible patient information and family involvement in rehabilitation.

The NHFD report makes four key recommendations for national commissioning bodies and other organisations planning healthcare:

Dr Sunil Nedungayil, senior clinical lead for the Falls Fragility Fracture Audit Programme, said:

‘The findings show that significant variation in hip fracture care remains across the UK. Where a patient is treated can have a greater impact on their chances of survival than many of the factors we typically associate with health inequalities.

We know what good care looks like. Delirium screening, prompt surgery, specialist multidisciplinary care and effective fracture prevention services all improve outcomes for patients, yet access to these interventions remains inconsistent.

Every patient who breaks a hip should receive high-quality care regardless of where they live or which hospital they attend. Reducing unwarranted variation must remain a priority if we are to improve outcomes and prevent avoidable harm.’

Dr Maria Panourgia, NHFD orthogeriatric clinical lead:

‘This year’s NHFD report highlights several key priorities to improve outcomes for people with hip and fragility fractures. Services should ensure routine delirium screening using the 4AT for all patients admitted with a hip fracture, strengthen local clinical governance through regular multidisciplinary review of outcomes and patient experience, and work to reduce unwarranted variation in care for patients with fragility fractures.

‘In parallel, stakeholders should support the universal provision of effective Fracture Liaison Services to ensure equitable access to secondary fracture prevention, osteoporosis management, and falls prevention across all regions.’

Dr Anastasios Nikolaidis, NHFD orthopaedic clinical lead:

‘The 2026 NHFD report emphasises the need for equitable and fair health care to prevent differences in access, treatment and outcomes. Significant differences exist between hospitals in key performance indicators and mortality outcomes.

‘This variation in care should be identified and challenged so that every patient, regardless of who they are or where they live, has the best possible opportunity for recovery and prevention of future fractures, through the establishment of effective Fracture liaison Services across the country.’

The NHFD collects data from hospitals across England, Wales, Jersey and Northern Ireland, to support improvements in the quality and outcomes of care for people who sustain hip fractures. It is one of many HQIP-commissioned national clinical audits that measure care across a variety of conditions. This report highlights the value of these programmes in improving healthcare and, ultimately, improving and saving lives. The data and outputs from this work are an invaluable, publicly available resource that shine a light on where improvements will have the maximum impact; supporting healthcare providers to implement changes that will improve care and outcomes for everyone.

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