Frailty, fragility fractures and healthy aging: turning challenges into opportunities

Advancements occurred in the last century have gradually extended human lifespan. However, increased lifespan does not necessarily coincide with an equivalent extension of healthy life expectancy. The increasing gap of years between healthy and unhealthy life challenges individual aspirations for a meaningful longevity and strains the sustainability of health and social care systems. Aging remains the main risk factor for diseases, and comorbidity does not fully account for the disparities between healthy and unhealthy life expectancy. Moreover, disease-modifying and healthcare interventions reducing mortality not necessarily restore individual vitality, neither preserve functional independence. Accordingly, chronological age or metrics for single or multiple non-communicable diseases (NCDs) cannot appropriately capture the individual quality of life. The geriatric and gerontological science advanced the frailty syndrome at the crossroad between healthy and unhealthy trajectories of aging. Frail older adults carry a complex combination of features related to physiological aging, minor and major multi-systemic alterations, that start as compensatory mechanisms and flow into NCDs pathophysiological attributes. Orthogeriatric patients are paradigmatic examples of frail older adults. As acute stress, hip fracture challenges individual resilience leaving the subjects on the edge between homeostatic balance or derangement, short-term functional recovery or long-term dependency, and ultimately premature death. Upon hospital admission, the comprehensive geriatric assessment (CGA) is pivotal to detect and manage frailty and consequences, to drive preventive and curative interventions in the short and long-term period, including secondary prevention of falls and fragility fractures. Starting from the first episode, falls and fragility fractures should be timely assessed using CGA as possible multifaceted features of frailty. Timely interventions removing modifiable risk factors are recommended to counteract the frailty vicious cycle, including falls and fragility fractures, causing unhealthy life expectancy. The Fracture Liaison Service (FLS) is a coordinated care model designed to bridge the care gap of people facing fragility fractures in a time-dependent manner. Building on professionals' knowledge and competencies for caring older adults, FLS may be an avenue to detect frailty and place actions to reinforce individual intrinsic capacity from the acute care setting to home, and from hip fracture patients to forward.