Care guidelines

Improving care for patients who have sustained a fragility fracture requires a coordinate approach that is identified through a Care Standard or Guideline. These have been developed and made available in many countries and often include resource tools for clinical management.


Sociedad Española de Fracturas Osteoporóticas (SEFRAOS). Libro Azul de la Fractura Osteoporótica en España. 2012.

United Kingdom

National Institute for Health and Care Excellence (NICE). The Management of Hip Fracture in Adults. 2011. NICE Clinical Guideline 124.
Updated 2017:

NICE Quality Standard 16.

Scottish Standards of Care for Hip Fracture Patients 2018:

Australia and New Zealand

Australian Commission on Safety and Health Care Clinical Standard for Hip Fracture Care (2016):

Bone and Joint Canada

United States of America

Bukata SV, Digiovanni BF, Friedman SM et al. A guide to improving the care of patients with fragility fractures. 2011.

American Academy of Orthopaedic Surgeons

Ontario (Canada)


Countries around the world collect and report data on the performance of their healthcare system in managing fragility fractures, with most countries focusing on hip fractures. Information on each country including their annual reports (where available) can be found here.

If you would like additional information about any of the registries you can contact through


United Kingdom (England and Wales)

National Hip Fracture Database:

United Kingdom (Scotland)

Australia and New Zealand




Bone Fit Canada

Evidence based exercise program for people with osteoporosis designed for health care and exercise professionals

Bone Fit USA

BoneFit USA: BoneFitTM is an evidence-informed exercise training workshop, designed for healthcare professionals and exercise specialists to provide training on the most appropriate, safe and effective methods to prescribe and progress exercise for people with osteoporosis. BoneFitTM includes two different levels of workshops – BoneFitTM Basics and BoneFitTM Clinical. BoneFitTM Basics workshops are aimed at exercise and fitness professionals. BoneFitTM Clinical workshops are aimed at rehabilitation professionals. BoneFitTM was created and launched by Osteoporosis Canada in 2010. BHOF is working with Osteoporosis Canada and the founders of BoneFitTM to bring this training program to the United States.

BoneFit directory:

Own the Bone Registry

American Orthopaedic Association


Physical Therapy Management of Older Adults with Hip Fracture

Purcell K, Tiedemann A, Kristensen MT, Cunningham C, Hjermundrud V, Ariza-Vega P, Perracini M, Sherrington C. Mobilisation and physiotherapy intervention following hip fracture: snapshot survey across six countries from the Fragility Fracture Network Physiotherapy Group. DisabilRehabil. 2021 Sep 12:1-8. doi: 10.1080/09638288.2021.1974107. Epub ahead of print. PMID: 34514916.

Perracini MR, Kristensen MT, Cunningham C, Sherrington C. Physiotherapy following fragility fractures. Injury. 2018 Aug;49(8):1413-1417. doi: 10.1016/j.injury.2018.06.026. Epub 2018 Jun 21. PMID: 29958686.

Dyer SM, Perracini MR, Smith T, Fairhall NJ, Cameron ID, Sherrington C, Crotty M. Rehabilitation Following Hip Fracture. 2020 Aug 21. In: Falaschi P, Marsh D, editors. Orthogeriatrics: The Management of Older Patients with Fragility Fractures [Internet]. Cham (CH): Springer; 2021. Chapter 12. PMID: 33347227.

Sheehan KJ, Fitzgerald L, Lambe K, Martin FC, Lamb SE, Sackley C. Effectiveness of community-based rehabilitation interventions incorporating outdoor mobility on ambulatory ability and falls-related self-efficacy after hip fracture: a systematic review and meta-analysis. Arch Osteoporos. 2021 Jun 19;16(1):99. doi: 10.1007/s11657-021-00963-0. PMID: 34148132; PMCID: PMC8214580.


Exercise recommendations: Too fit to Fracture
Bone health and osteoporosis Foundation: Exercise resources
NIH Osteoporosis and Related Bone Disease National Resource Centre



Sherrington C, Fairhall N, Wallbank G, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb S. Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. Br J Sports Med. 2020 Aug;54(15):885-891. doi: 10.1136/bjsports-2019-101512. Epub 2019 Dec 2. PMID: 31792067.

M, von Stengel S, Kohl M, Schoene D, Kemmler W. Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters. Osteoporos Int. 2020 Aug;31(8):1427-1444. doi: 10.1007/s00198-020-05441-w. Epub 2020 May 12. PMID: 32399891; PMCID: PMC7360540.

Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res. 2018 Feb;33(2):211-220. doi: 10.1002/jbmr.3284. Epub 2017 Oct 4. Erratum in: J Bone Miner Res. 2019 Mar;34(3):572. PMID: 28975661.

Giangregorio LM, Ponzano M. Exercise and physical activity in individuals at risk of fracture. Best Pract Res Clin Endocrinol Metab. 2022 Mar;36(2):101613. doi: 10.1016/j.beem.2021.101613. Epub 2022 Jan 6. PMID: 35210190.

Secondary prevention programs

Fracture Liaison Services

New South Wales, Australia

NSW Agency for Clinical Innovation Model of care for Osteoporotic Refracture Prevention 2nd ed (2018) availableat:

Falls Prevention


USA Policy documents 

Policy Institute:

Medicare Cost Of Osteoporotic Fractures – 2021 Report:

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