WHO benchmarks for equitable hip-fracture care and osteoporosis treatment in older people

Hip fractures cause major morbidity, mortality and long-term disability among older persons worldwide. The World Health Organization has defined two key indicators within the framework of the UN Decade of Healthy Ageing to measure health system performance in providing care for older adults with hip fractures: the proportion who receive surgery within 48 h of fracture; and the proportion who receive pharmacological treatment for osteoporosis post-fracture. This Perspective article, which describes the clinical importance of these indicators, their amenability for adoption and implications for health equity, is based on findings from audits, guidelines and key literature. Numerous evidence-based solutions - for example, fracture liaison services, orhtogeriatric care models and digital tools support hip-fracture management, yet major barriers remain, such as data gaps, system preparedness and pathway variability. New or modified policies developed by national governments, ministries of health and other relevant authorities and tailored to specific geopolitical contexts are urgently needed to enable the implementation of timely surgical care and secondary fracture prevention strategies aligned with the WHO indicators. Improved health information systems to measure performance and to ensure translation to real-world changes in the lives of older people worldwide are of paramount importance.