Disability & Rehabilitation, 2013; 35(9): 758–765

© 2013 Informa UK, Ltd.

ISSN 0963-8288 print/ISSN 1464-5165 online
DOI: 10.3109/09638288.2012.707747

Perspectives in Rehabilitation

 ole of comprehensive geriatric assessment in the management

R
of osteoporotic hip fracture in the elderly: an overview

Marina De Rui, Nicola Veronese, Enzo Manzato & Giuseppe Sergi

Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy

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Purpose: To highlight the advantages of comprehensive Implications for Rehabilitation

geriatric assessment (CGA) over usual care in the management
of elderly patients with fragility hip fractures in terms of Orthogeriatric management
reducing the related mortality and disability. Method: An
overview of publications on the topic was conducted using • Fragility hip fracture in older people is burdened by
the MEDLINE and EMBASE databases. Results: Several models an elevated incidence of complications, mortality and
of geriatric and orthopedic comanagement have been disability.
Disabil Rehabil 2013.35:758-765.

developed in recent years, all characterized by a variable
degree of integration, and they have been shown to reduce
complications, disability and mortality in elderly hip-fracture
patients. Preoperatively, CGA should identify the comorbidities
that need to be treated in view of surgery, so as to reduce
the related risks. After surgery, CGA should deal with medical
complications and assure patients an early mobilization in
order to reduce short-term mortality and contain functional
decline. Before discharge, the orthogeriatric team should draw
up a tailored program to promote the patient’s functional
recovery and satisfactory quality of life, also covering the
secondary prevention of fragility fractures by improving bone
quality and reducing the risk of falls. Conclusions: Fragility hip
fractures in the elderly people need to be managed by different
professionals working in close cooperation and adopting a CGA.
Keywords: Comprehensive geriatric assessment, elderly, hip
fracture
Introduction
Fragility hip fractures occur in older adults [1] and represent
a growing problem for clinical, social and financial reasons.
Surgical correction is considered the most appropriate treat-
ment for hip fracture and has been extended over the years to
frailer and older patients. The coexistence of multiple chronic
disorders in such patients [2] raises the risk of peri- and post-
operative complications that may impair their functional recov-
ery and raise the short- and long-term mortality rates [3]. The
• The global complexity of elderly people with hip
fracture requires an orthopedic and geriatric
comanagement.
• The application of the comprehensive geriatric assess-
ment during hospital stay is the best approach for the
management of the elderly people with hip fracture.
• Before discharge the multidisciplinary team should
design a tailored rehabilitation plan and should also
consider the secondary prevention of hip fracture.
approach to the more elderly patients with hip fractures thus
requires both surgical management and geriatric handling [4].
The clinical effectiveness of comprehensive geriatric
assessment (CGA) has been known for some time. Its use is
associated with improvements in the clinical management of
elderly patients and an optimization of their passage through
the health service network [5,6]. In recent years, several models
of geriatric and orthopedic cooperation have been developed
and implemented around the world [7]. Even if they differ in
some aspects, they are all characterized by an integration of
the surgical approach with a CGA, which is known to take
an interdisciplinary and multidimensional approach. This
model of care has proved successful in reducing in-hospital
complications [8,9], length of hospital stay [10], readmission
rate [10], disability and mortality [9] in elderly patients with
osteoporotic hip fractures.
The aim of this work was to highlight the importance of
the geriatrician’s role in the management of elderly patients

Correspondence: Dr. Giuseppe Sergi, Clinica Geriatrica – Ospedale Giustinianeo (2° piano), via Giustiniani 2, 35128, Padova, Italy.
Tel.: 0039-049–8218492. Fax: 0039-049–8211218. E-mail: giuseppe.sergi@unipd.it
(Accepted June 2012)

758

with hip fractures, and to identify the essential steps that geri-
atricians should take to reduce patients’ short-term mortality,
facilitate their admission to a rehabilitation program and thus
contain their long-term disability.
Methods
A literature database search was performed electronically via
OVID (MEDLINE and EMBASE), combining the term “hip
fracture” with the following MeSH keywords: “management”,
“geriatric” “multidisciplinary”, “comanagement”, “co-care”,
“approach”, “comprehensive geriatric assessment”. The term
“orthogeriatric” was sought separately. We also performed
specific searches on effective inpatient care models for hip
fracture patients. The search was restricted to articles pub-
lished in the English language from 1980 to January 2012.
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In addition, a manual check on the reference lists in the
articles and reviews identified was also conducted to seek
any additional sources of information. Data were extracted
independently by two investigators. The criteria for includ-
ing the articles in this overview were randomized controlled
trials and observational clinical studies on the management
of hip fracture in elderly people. The exclusion criteria were
certain types of publication (letters to editors or single case
reports) and patients with a mean age below 60 years. The
Disabil Rehabil 2013.35:758-765.
outcome measures examined were: mortality, length of hospi-
tal stay, functional status, medical complications, destination
after discharge, recurrent fracture risk and the prescription of
antiresorptive drugs. Among 119 studies identified, 68 met
the inclusion and exclusion criteria, and were eligible for our
analysis.
Reasons for orthogeriatric comanagement
The main reasons why elderly people with hip fractures
need orthogeriatric comanagement are: their age [11] and a
high prevalence of comorbidities [12], accounting for their
remarkable global complexity and frailty. These conditions
are most likely to give rise to perioperative medical and sur-
gical complications, and to accelerate functional decline and
mortality [13].
The fragility hip fracture rate increases exponentially with
age, especially over 75-year-old [11], and the mean age of hip
fracture patients is likely to rise in years to come. According to
Morin et al. [12], moreover, 97% of patients admitted for hip
fractures have more than one concomitant disease, and 44%
have more than six comorbidities. Patients with ≥3 chronic
medical conditions have a 2.5-fold risk of death [3], and this
risk increases with the severity of their concomitant chronic
diseases [14]. Finally, a variety of perioperative medical
complications are reported in these patients [10], especially
cardiovascular and respiratory events, which give them an
eight-fold short- and mid-term mortality risk [3].
In addition, the high disability rate after hip fracture coin-
cides with family and social changes that also contribute to
the need for a tailored discharge plan.
All these factors underscore the need for an integrated
multidimensional and interdisciplinary approach to address
© 2013 Informa UK, Ltd.
Hip fracture and CGA in the elderly 759
the clinical and social complexity of elderly hip fracture
patients.
Comprehensive geriatric assessment
In clinical practice, geriatricians make use of a CGA, a mul-
tidimensional process that has long prevailed as the best
approach to the management of elderly patients. It requires
an interdisciplinary team consisting of nurses, occupation
and physical therapists, general practitioners and geriatric
physicians. CGA can make use of several evaluation tools
to explore an elderly patient’s clinical, functional, cognitive,
nutritional and social domains and thus obtain a global pic-
ture, optimize the patient’s long-term treatment, and plan the
resources required and the use of services.
Several scales are available for use in CGA to quantify a
patient’s performance and follow it up over time, and they are
also useful for estimating the mortality risk [15].
The standard evaluation scales are: the activities of daily
living (ADL) [16] and instrumental activities of daily living
(IADL) [17] indexes for defining the level of functional depen-
dence/independence; the Mini Mental State Examination
(MMSE) [18] for assessing cognitive status; and the Mini
Nutritional Assessment (MNA) [19] to examine the patient’s
nutritional status.
The clinical usefulness of the CGA for elderly inpatients
had already been demonstrated in the 1980s, indicating ben-
efits for standard medical care in terms of a better cognitive
and functional status, a lower mortality rate and a diminished
usage of acute care and long-term institutional services [5].
The particular features and potential of the CGA make it
useful in managing elderly patients with hip fractures too.
This is a field in which CGA has proved capable of improving
functional outcomes and reducing mortality rates and health-
care costs, both during hospitalization and in the patient’s
long-term follow-up [7,20].
Models of orthogeriatric integration
Taking the traditional approach, a patient with a hip fracture
is admitted to an orthopedic ward where an orthopedic team
provides medical, surgical and nursing care, referring to con-
sultants to cope with specific issues if necessary.
Because patients with hip fractures are often elderly and
have comorbidities [11,12], ever since the 1950s models of
orthogeriatric cooperation have been developed and imple-
mented worldwide, providing for an integrated management
by a geriatric and orthopedic team, taking an interdisciplinary
and multidimensional approach typical of CGA.
As proposed by Kammerlander et al. [7], this orthogeriat-
ric integration can take place according to four main models
(Table I):
Model 1: Orthopedic ward and geriatric consultant
service – this model resembles the traditional approach.
Patients are admitted to the orthopedic ward and managed
by the orthopedic team. If necessary, a geriatrician’s opin-
ion can be requested to deal with specific issues. Compared
to the traditional method, this model has achieved better
 760 M. De Rui et al.
Table I. Studies included in the analysis of orthogeriatric models
Source
Kennie et al. (1998) [21]
Naglie et al. (2002) [22]
Ho et al. (2009) [20]
Zuckerman et al. (1992)
[23]
Antonelli Incalzi et al.
(1993) [28]
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Marcantonio et al. (2001)
[24]
Roberts et al. (2004) [29]
Koval et al. (2004) [27]
Disabil Rehabil 2013.35:758-765.
Shyu et al. (2005) [26]
Fisher et al. (2006) [25]
Gilchrist et al. (1988) [31]
Stenvall et al. (2007) [30]
Khasraghi et al (2005) [8]
Vidan et al. (2005) [9]
Friedman et al. (2009) [10]
Gregersen et al. (2012)
[32]
RCT, randomized controlled trial; ADL, activities of daily living.
Disability & Rehabilitation
Model Type Sample (age) Main outcomes (orthogeriatric management vs usual care)
1 RCT 108 patients (>65) Higher rate of patients independent in ADL (41 vs. 25%)
Shorter hospital stay (24 vs. 41 days).
Lower institutionalization rate (10 vs. 32%)
1 RCT 279 patients (>70) No significant differences in disability rates and placement 6
months after surgery
2 Prospective 554 patients (>65) Lower time to surgery (1 vs. 2 days; p = 0.001), shorter hospital stay
(8.3 vs. 9.7 days, p = 0.001); lower short- and long-term mortality
(p < 0.05)
2 Prospective 491 patients (>65) Fewer post-operative complications (p < 0.05) and transfers to
intensive care units (p < 0.001)
Higher percentage of patients with improved walking ability
(56.3 vs. 18.2%)
Lower institutionalization rate (8.1 vs. 19.3%)
2 Prospective 761 patients (≥70) Lower mortality rate (p < 0.01), no significantly shorter hospital
stay
2 RCT 126 patients (>65) Lower risk of delirium (OR = 0.64; 95% CI: 0.37–0.98; p < 0.05) or
severe delirium (OR = 0.40; 95% CI: 0.10–0.89; p < 0.05)
2 Prospective 369 patients (>65) Longer hospital stay (+6.5 days; p < 0.0005)
Greater improvement in ambulation at discharge (OR = 1.6, 95%
CI: 1.0–2.6, p = 0.033)
Trend towards fewer admissions to long-term care (OR = 0.6, 95%
CI: 0.3–1.0, p = 0.058)
2 Retrospective 1065 patients (>65) Shorter hospital stay (13.7 vs 21.6 days)
Lower in-hospital (1.5 vs 5.3%) and 1-year (8.8 vs 14.1%) mortality
rates
2 RCT 137 patients (>65) Better physical function (hip flexion, walking, ADL, quadriceps
peak force)
Greater reduction in body pain and better mental health
2 Prospective 951 patients (>60) Fewer post-operative medical complications (49.5 vs. 71.0%;
p < 0.001), lower mortality rate (4.7 vs. 7.7%; p < 0.01) and
6-month rehospitalization rate (28 vs. 7.6%)
Higher rate of antiresorptive (12–69%; p < 0.01) and anti-throm-
botic (63–94%; p < 0.01) drug prescriptions
No difference in-hospital stay or discharge destination
3 RCT 222 patients (>65) No difference in mortality, hospital stay or discharge destination
3 RCT 199 patients (>70) Higher probability of regaining independence in ADL at 4 and 12
months (OR = 2.51; 95% CI: 1.00–6.30 and OR = 3.49; 95%
CI: 1.31–9.23)
Higher probability of improving functional status (OR = 3.01;
95% CI: 1.18–7.61)
4 Retrospective 510 patients (>65) Lower time to surgery (63 vs. 35% had surgery within 24 h)
Fewer medical complications (36 vs. 51%)
Shorter hospital stay (5.7 vs. 8.1 days)
4 RCT 395 patients (>65) Shorter hospital stay (16 vs. 18 days; p = 0.06)
Lower in-hospital mortality (0.6 vs. 5.8%; p = 0.03) and complica-
tions (45.2 vs. 61.7%; p = 0.003)
Higher rate of recovery at 3 months (57 vs. 44%; p = 0.03)
4 Prospective 314 patients (>65) Shorter time to surgery (24.1 vs. 37.4 h) and hospital stay (4.6 vs.
8.3 days)
Fewer post-operative infections (2.3 vs. 19.8%) and complications
(30.6 vs. 46.3%)
4 Retrospective 495 patients (>65) Shorter hospital stay (15 vs. 13 days)
Higher antiresorptive drug prescription rate (67 vs. 2%)
No significant differences in institutionalization, readmission and
mortality rates.

functional outcomes, shorter hospital stays (24 vs. 41 days
on average) and lower institutionalization rates [21], even
for demented patients [22];
Model 2: Orthopedic ward and daily consultation
service – this is a variant of Model 1, the difference being
that the geriatrician is consulted daily, not only “on request”.
Geriatricians continue to act only in an advisory capacity,
however. This model has been seen to coincide with signifi-
cantly fewer medical and surgical complications [23–25],
lower rates of disability [26] and in-hospital [25,27] or
long-term mortality [28,29], and ultimately a reduction in
healthcare costs [20];
Model 3: Geriatric ward and orthopedic consultation
service – this has led to better functional outcomes [30],
but has been unable to significantly reduce the mortality
rates [31];
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Model 4: Orthogeriatric service – this is the model with the
greatest degree of complexity and integration, since the
orthopedic and geriatric teams jointly manage the patient
from admission to discharge. They are assisted by an in-
terdisciplinary team that includes nurses, social workers,
physiotherapists, dieticians, and others. This model has re-
duced the time to surgery [8], medical complications [8,9],
length of hospital stay [10], readmission and disability
rates [9,10] and in-hospital and long-term mortality rates
Disabil Rehabil 2013.35:758-765.
[9]. According to Gregersen et al. [32], moreover, by com-
parison with the usual care, this integrated approach pays
more attention to the secondary prevention of fractures, as
demonstrated by a higher percentage of patients discharged
with a prescription of calcium/vitamin D (67 vs. 2% under
the usual care) and antiresorptive therapy (10 vs. 1%).
Figure 1. Flowchart showing the role of comprehensive geriatric assessement (CGA) in the management of hip fragility fracture in the elderly patients.
© 2013 Informa UK, Ltd.
Hip fracture and CGA in the elderly 761
CGA for the elderly with hip fracture
Whatever the orthogeriatric model used the cooperation
between orthopedic and geriatric specialists and the other team
members should ensure a multidimensional assessment with a
view to restoring patients to their previous clinical, functional
and cognitive status. CGA should investigate the patient’s pre-
fracture clinical, cognitive and functional profile in order to
alert the team to any potential perioperative complications and
establish an achievable functional recovery plan.
CGA should be completed and then revised throughout
the hip fracture patient’s time in hospital – from admission
to discharge – and it should give rise to an appropriate, tai-
lored discharge plan. The best way to ensure a high degree
of integration between the operators involved is to adopt the
orthogeriatric model.
Figure 1 shows the main objectives of CGA and the actions
it should trigger in the pre- and post-operative stages, and
before discharge.
Preoperative phase
In the preoperative phase (Figure 1), the multidimensional
assessment should focus on operating the patient as quickly
as possible and with the lowest possible risk.
As shown in Table II, comorbidities are very common in
elderly people with hip fractures and a sizable percentage of
these patients have acute medical problems or flare-ups at the
time of their hospital admission.
CGA should therefore analyze the severity of coexisting
chronic diseases and identify any pathological conditions that
the fracture may have brought to light. The number of a patient’s
 762 M. De Rui et al.
comorbidities on admission is directly associated with the onset
of post-operative complications, the short-term mortality rate
[3,33], mid- and long-term functional impairment [34] and the
refracture risk [35]. According to Roche et al. [3], patients with
three or more concomitant diseases have a 30-day mortality
risk about 2.5 times higher than patients with no comorbidities.
Given the high prevalence of chronic diseases among hip
fracture patients [14], the CGA should help the orthogeriatric
team to identify which of the patient’s comorbidities take the
highest priority for treatment [36]. The orthogeriatric team’s
assessment and action should be as prompt as possible to reduce
the time to surgery because any delay raises the incidence of post-
operative medical complications, regardless of any pre-existing
comorbidities [37], and is associated with a higher short- and
long-term mortality risk (OR: 1.41 and 1.32, respectively) [38].
CGA should also investigate the presence and intensity
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of pain, which often goes verbally unexpressed and con-
sequently undertreated in the elderly [39], particularly in
demented patients [40]. Untreated pain worsens quality of
life, accelerates cognitive decline [41] and increases the risk of
delirium (RR: 5.4), even in patients who were previously not
cognitively impaired [42].
Finally, the preoperative assessment should explore nutri-
tional status, identify conditions of malnutrition and ensure a
tailored calorie intake. Low albumin levels and BMI increase
Disabil Rehabil 2013.35:758-765.
long-term mortality (OR: 5.8 and 1.16, respectively) [43],
while protein supplementation reduces post-operative com-
plications [44].
Postoperative phase
In this phase (Figure 1), the main goals of the orthogeriatric
team should be to reduce the short-term mortality rate and
prevent mental and functional decline. This phase is burdened
by a high mortality rate, especially during hospitalization and
in the first 3 months after surgery [11], probably due to the
combined effects of the trauma, major surgery, comorbidities
and low physiological reserves [45].
Previous studies [9,10,46,47] have shown that the in-
hospital mortality rates vary between 2.5 and 10%, then level
Table II. Common comorbidities and acute or exacerbated medical
problems in elderly patients admitted for fragility hip fracture (range of
prevalence in the different studies).
Comorbidities %
Hypertension 42–55 [4,9,33,34]
Cardiovascular disease 24–45 [3,4,33]
Dementia 18–46 [9,33]
Asthma or COPD 5-16 [3,11]
Cerebrovascular disease 11–18 [3,4,11,33]
Diabetes 9–23 [3,4,9]
Cancer 8–12 [3,11,33]
Renal disease 3 [3]
Acute medical problems or flare-ups on admission
Poorly compensated heart failure 13–30 [14,33]
Blood pressure abnormality 17 [14]
Respiratory failure 7.4 [14]
Abnormal INR 6–6.5 [14]
COPD, chronic obstructive pulmonary disease; INR, international normalized ratio.
Disability & Rehabilitation
off at around 10% at 30 days [3], reaching almost 20% after 3
months [11].
In the early post-operative period, the interdisciplinary
team should investigate and handle possible complications of
surgery and its interaction with the patient’s comorbidities.
The more common post-operative complications are shown
in Table III: the conditions that most influence perioperative
mortality are heart failure (HR = 8), lung infections (HR =
3.9) and pulmonary thrombo-embolism (HR = 4.5) [3].
While the primary role of CGA in this phase is to contain
the high mortality rate, limiting functional and mental decline
should also be considered an important goal. The high dis-
ability rate following hip fracture may modify patients’ pas-
sage through the health service network after discharge [47].
Taking their pre-fracture walking ability into account, the
orthogeriatric team should do its utmost to assure patients
an early mobilization and speedy rehabilitation [48] in order
to reduce the incidence of complications [49] and improve
the patients’ mid- and long-term functional autonomy
[50,51]. CGA should also provide pain treatment because
post-operative pain is associated with a greater long-term
functional dependence [52], and it should manage cogni-
tive and behavioral issues to prevent the onset of delirium,
which in itself doubles the risk of functional impairment and
death [53–55].
Maintaining an adequate nutritional status is another
important aspect to bear in mind during a patient’s hospital
stay because metabolic stress and fasting periods for the pur-
pose of diagnostic tests and anesthesia can precipitate latent
conditions of malnutrition [56]. A poor nutritional status is
associated with a higher rate of complications and death [57].
Frail elderly patients given a more caloric diet and protein
supplementation after hip fracture repair had a better muscle
performance than controls who did not receive the same
supplementation [58]. In addition to the anthropometric
parameters and biohumoral markers of nutritional status and
hydration, the multidisciplinary team should also consider
the patient’s ability to eat properly unassisted. Duncan et al.
[46] found that introducing dietetic or nutritional assistants
in an acute trauma ward to encourage and assist elderly
patients at mealtimes improved their calorie intake and
nutritional status, and reduced their in-hospital and 4-month
mortality.
Table III. Common complications after hip fracture surgery in the
elderly patients (range of prevalence in the different studies).
Complications %
Delirium 28.3 [10]
Infections 11–13 [3,9,10,37]
Pressure sores 11.8 [9,37]
Heart failure 4.2–5 [3,9,10]
Arrhythmia 1.6 [9]
Renal failure 6.8 [10]
DVT/PE 2–5.3 [3,10,37]
Bleeding 1–1.6 [3,10]
Myocardial infarction 1 [3]
Stroke 0.5–1 [3,10]
DVT/PE, deep vein thrombosis/pulmonary embolism.

Before discharge
Before discharge, the orthogeriatric team should reassess
patients to pinpoint their global complexity and the amount
of care they need, drawing up an appropriate program to
promote their global recovery. The overall objectives of the
discharge plan are to facilitate a functional recovery, preserve
the patient’s active involvement in life and restore their prior
living conditions as far as possible. Tailored discharge plans
should involve patients’ families and consider their prior
functional status and post-fracture mobility, their self-care
ability, any caregiver’s competence, and the social support
available.
Another crucial issue concerns the secondary prevention
of fragility fractures, which includes reducing the risk of falls
and improving bone quality.
Patients who have had a hip fracture are at high risk of
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recurrent falls and more than 53% of them fall at least once
in the 6 months following discharge [59]. CGA has proved
helpful in reducing the incidence and severity of post-fracture
falls by means of periodic medication reviews to eliminate any
unnecessary medication (especially psychoactive drugs), treat
hypotension, improve visual acuity, provide assistive devices
and physical therapy, including balance, strength and endur-
ance training [30]. The prevention of falls should also include
the assessment and management of environmental hazards,
Disabil Rehabil 2013.35:758-765.
e.g. removing clutter and loose rugs, adding stair rails and
grab bars, and improving lighting [60].
Osteoporosis is a common disease in the elderly [61] and
for patients who have already had a fragility hip fracture
the risk of further fracture is estimated to increase 1.9- and
3.5-fold for women and men, respectively [62]. Vitamin D
deficiency is also common in the elderly [63,64], and is asso-
ciated with hip fracture risk and severity [65,66]. Less than
one in three patients with low-impact fractures are tested for
osteoporosis, however [67], and less than 18% of them receive
the complete treatment recommended in the evidence-based
guidelines [68]. Among patients admitted to hospital with a
second hip fracture, only 10% had been taking any kind of
treatment (calcium, vitamin D or antiresorptive therapy) for
osteoporosis during the previous 6 months [65]. While ortho-
geriatric intervention should identify cases of osteoporosis
going under-treated, CGA should help clinicians distinguish
between patients who may or may not benefit from this treat-
ment. Bedridden patients and those with a life expectancy of
only a few months will certainly not benefit from therapy for
osteoporosis because it will not have time to have any notice-
able effect whereas it might expose the patient to adverse
effects.
One of the main aims of the discharge plan is to address
patients to the most appropriate rehabilitation program.
CGA should help clinicians to identify patients potentially
suitable for early discharge home and those who need an
inpatient rehabilitation setting. In the last 30 years, in addi-
tion to geriatric orthopedic rehabilitation units, home-based
(HB) supported discharge solutions have emerged as a valid
rehabilitation strategy for medically fit patients who lived at
home with a relative or caregiver before they were admitted
© 2013 Informa UK, Ltd.
Hip fracture and CGA in the elderly 763
to hospital [69]. Both these approaches demand a multidisci-
plinary team and effectively improve the functional recovery
of elderly people after a hip fracture.
Conclusions
Fragility hip fractures in the elderly patients need to be man-
aged differently from fractures in younger adult patients. The
clinical and social complexity of elderly patients demands a
close cooperation between different professionals (orthopedic
specialists, anesthesiologists, geriatricians, physiotherapists,
and nurses). The primary goals of the orthogeriatric team
should be to reduce the complications, mortality rate and
functional impairment. The team should also refer patients
to the most appropriate rehabilitation program with a view
to reducing the need for institutionalization and facilitating
the patients’ functional recovery and reintegration in their
social network. The discharge plan should also include the
prevention of secondary hip fractures by treating osteopo-
rosis and reducing the risk of falls. The orthogeriatric team
should conduct and extend the use of comprehensive geriatric
assessments.
Declaration of Interest: The authors have no conflict of inter-
est to declare. No funds were used for the preparation of this
overview.
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