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The main consequences of osteoporosis are that it is a condition in which bone mass is depleted and bone structure is destroyed to the degree that bone becomes fragile and prone to fractures. For affected patients, these ‘fragility fractures’ are associated with substantial pain and suffering, disability and even death, along with substantial costs to society. The problems created by fragility fractures and osteoporosis are multifactorial in origin and are, therefore, a multidisciplinary problem. A first fragility fracture is often the first sign of osteoporosis, and ‘secondary’ prevention of fragility fractures is focused on the prevention of further fractures once an initial fracture has occurred. Nurses play a key role in education and guidance of patients with osteoporosis. This chapter will provide an overview of how osteoporosis and fragility fractures are linked, with a focus on fracture prevention.

Research confirms that frailty, sarcopenia and falls are strongly correlated [1] and both are predictors of negative health outcomes such as falls, disability, hospitalisation and death [2]. Interventions are necessary to reverse frailty and treat sarcopenia [3] as it has been estimated that, by the year 2025, around 20% of the population in industrial countries will be aged 65 years and over. As the number of older people increases, their needs will become an increasingly important health issue. Reduction in physical function can lead to loss of independence, need for hospital and long-term nursing home care and premature death. The importance of physical, functional, psychological and social factors in realising a healthy old age is recognised by older people, health-care professionals, policy advisors and decision-makers.

The most common cause of fractures in the elderly is falling, usually from standing height, and falling is the leading cause of hospitalisation due to accidental injury, with significant risk of death in the following year due to complications [1]. Low bone density due to osteoporosis or osteopenia means that falls easily result in fractures, even when the fall dynamics are relatively mild, as discussed in Chap. 1. These are often referred to as ‘fragility’, ‘osteoporotic’ or ‘minimal trauma’ fractures and most commonly occur in those over the age of 50 years [2], the same population at risk of osteoporosis.

As the incidence of fragility fractures continues to rise, healthcare professionals will encounter patients with fractures in a variety of clinical settings such as falls clinics, intermediate care services and acute medical wards. Older people with fragility fractures are a diverse group, and their care needs are complex. Although some have comparatively few health problems, many have a series of interconnected illnesses and psychological and social problems requiring a range of therapeutic interventions. The primary focus of care is to meet the needs of the older person following skeletal trauma throughout their care pathway and ensure that they receive the same high standard of specialist care within orthopaedic services as they would within a setting specialising in the care of older people. The central philosophy should be holistic care using a person-centred approach that brings the various aspects of specialist care together.

As the population ages, musculoskeletal trauma in older people will be a growing challenge. Although management of older people following trauma has some similarities to that for all trauma, there are also differences and specific considerations relating to aging. The most common cause of injury in older people is a fall, so fall-related trauma will be the focus of this section while acknowledging that the care of elderly trauma, whatever the cause, is based on the same principles.

The positive effects of physical activity on physical and mental health are well known and include weight control, improved balance, flexibility, strength, anxiety reduction and protection from ill health, as well as contributing to independent living and preventing falls. Being mobile and able to self-care and fear of falling are important to patients. A central goal of nursing care following fragility fracture is to maximise mobility. Individual patient goals are determined by their pre-fracture mobility and functional status. Recovery is often compromised for those with limited pre-fracture activity and cognitive impairment, low functional levels postoperatively, older age, polypharmacy, comorbidities, depression, poor nutritional status, lack of social support and not living independently. Many patients never recover their previous level of function after a fragility fracture, and there is significant risk of institutionalisation, new fractures, disability and loss of independence.

The management of wounds and the prevention of pressure injuries (also known as pressure ulcers) are fundamental aspects of the management of the patient following fragility fracture, especially following hip fracture and associated surgery. Ageing skin and multiple comorbidities are significant factors in skin injury and wound healing problems. The aim of this chapter is to provide the reader with an overview of evidence-based approaches to the prevention of pressure injuries and to wound management following hip fracture surgery.

Malnutrition and dehydration are important aspects of the care of older people, particularly those in hospitals or in long-term care facilities. Many older people do not eat and drink adequately during hospital stays, and following hip fracture many patients achieve only a half of their recommended daily energy, protein and other nutritional requirements [1]. This leads to poor recovery and diminished health status and functional ability and results in a higher risk of other complications (Chap. ).

Cognitive syndromes are common in the older surgical patient. This chapter aims to provide an overview of the causes of altered cognitive function, provide advice on strategies that can be used to identify those at risk and give examples of assessments and interventions to aid diagnosis and treatment. The focus will be on acute confusion or “delirium” but will also comment on how existing cognitive impairment, dementia and depression can impact on patient recovery.

Fragility fracture is the result of a combination of bone fragility and falls and often leads to hip fracture, a devastating injury for both the patient and their family. The recovery process requires both physical and psychosocial care [1], and much research has focused on physical function, including post-hospital discharge and rehabilitation. All patients presenting with a fragility fracture following a fall should have a full multidisciplinary assessment and interventions to prevent future fractures and falls. The care, rehabilitation and discharge of patients with hip fracture are a significant challenge for many services, but the quality and cost-effectiveness of such care vary considerably. This chapter aims to discuss the role of the nurse in the rehabilitation and hospital discharge phases of the care trajectory.