Trends in secondary prevention of hip fracture: National Hip Fracture Database (NHFD) data for England, Wales and Northern Ireland
Abstract
Trends in secondary prevention of hip fracture: National Hip Fracture Database (NHFD) data for England, Wales and Northern Ireland
Antony Johansen, Will Eardley and Liz Fagan
Introduction
Patients with a hip fracture are at ‘imminent risk’ of further fragility fractures. In 2021 the NHFD introduced a new ‘key performance indicator’ (KPI7: the proportion of people known to be on bone protection 120-days after hip fracture) specifically to address this. In 2023 the ‘Call to Action’ paper published in Age and Ageing challenged clinicians to respond by giving a first dose of intravenous zoledronate during patients' inpatient stay.
Method
We set out to monitor the impact of these two drivers for improvement, monitoring trends in prescribing across the different hospitals of England, Wales and Northern Ireland, using data made available by the NHFD website www.nhfd.co.uk.
Results
In 2020 just 29.2% of people were identified as meeting KPI7, but by this figure had doubled to 59.0% (for patients admitted in August 2025). The main reason for this was not increasing rates of prescription (the proportion of people so treated on discharge only rose from 50.8% to 62.2%), but increasing awareness that poor persistence with oral bisphosphonates meant that few patients were still taking this at 120-days.
Oral medication had been the commonest approach, being prescribed for 31.5% of patients in 2020, but this fell to just 7.6% in 2025. In contrast, injectable medication rose from 14.3% to 52.2%, primarily because use of intravenous zoledronate quintupled, from 9.2% to 47.2% over the same period.
Conclusion
Most people (59%) are now known to be benefitting from long-term bone protection 120-days after a hip fracture, with another 15% referred for this to be considered.
This picture reflects a dramatic improvement in the use of intravenous zoledronate in place of oral bisphosphonates, particularly following the publication of the ‘Call to Action’. in September 2023. All geriatricians should now consider how they extend such fracture prevention to the other high-risk groups under their care.