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A phase-of-care approach to improve geriatric fracture care

Nature Aging (2025)Cite this article

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Improving outcomes for older adults with fractures requires more than treating the injury; it requires coordinated, multidisciplinary care. As the population ages, geriatric fractures — particularly those related to osteoporosis — are rising sharply. In the USA, the population aged 65 years and older is projected to grow from 35 million in 2000 to 86 million by 2050, with those aged 85 years and older increasing fivefold. Osteoporotic fractures alone are expected to surge by nearly 70% by 2040 (ref. 1), and to contribute to substantial morbidity, mortality and healthcare costs. Most osteoporotic fractures are low-trauma ‘fragility fractures’ that occur on the background of frailty, a state of reduced physiologic reserve that raises the risk of adverse outcomes even in otherwise-independent older adults. Critically, falls are the proximal trigger for most of these injuries. Despite this burden, post-fracture care remains fragmented and often overlooks the complex needs of older adults. This Correspondence outlines a practical, phase-of-care model — which spans primary prevention, acute management, secondary prevention and rehabilitation — to illustrate how involving geriatricians in close collaboration with orthopedic surgeons and other healthcare professionals can improve outcomes across the continuum of care. By embedding the ‘geriatric 5 Ms’ (mind, mobility, medications, multicomplexity and ‘what matters most’) in routine practice, this model promotes co-management that enhances recovery and helps older adults to maintain their independence and quality of life.

In the USA, 1 in 2 women over 50 will experience an osteoporosis-related fracture in their lifetime. A standard osteoporosis test called a bone density scan (dual-energy X-ray absorptiometry) can diagnose osteoporosis before a fracture occurs. Because falls precipitate most fragility fractures, primary prevention should pair osteoporosis identification and treatment with routine falls-risk screening (a brief gait and balance assessment) and targeted multicomponent exercise. Despite recommendations for dual-energy X-ray absorptiometry in adults aged 65 years and older, the number of US physicians offering this test has declined by 26% since 2008 (ref. 2). Moreover, the increasing lifespan, a growing Medicare population, and the underdiagnosis and undertreatment of high-risk patients are projected to drive fracture rates and related costs upward by nearly 70% by 2040 (ref. 1). Implementing policy changes that tie higher reimbursement to beneficial osteoporosis interventions could help to reverse this trend. Studies show that emphasizing fracture risk evaluation can boost dual-energy X-ray absorptiometry testing and treatment rates by up to 50%, and adding a care coordinator or case manager may increase bone density testing, treatment initiation and adherence by as much as 30%. For implementation in the clinic, we propose to use electronic health record prompts in adults aged 65 years or older, perform annual falls-risk screening, and deprescribe sedatives and anticholinergics that increase fall risk. These steps will raise screening and treatment uptake while containing costs.

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Author information

Author notes

  1. These authors contributed equally: Andrew Nguyen, Philip M. Lee.

Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    Andrew Nguyen

  2. Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

    Andrew Nguyen, Edward K. Rodriguez & Ara Nazarian

  3. John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA

    Philip M. Lee

  4. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

    Lewis Lipsitz & Karen Chahal

  5. Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA

    Lewis Lipsitz

  6. Department of Orthopaedic Surgery, Yerevan State University, Yerevan, Armenia

    Ara Nazarian

Authors
  1. Andrew Nguyen
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  2. Philip M. Lee
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  3. Edward K. Rodriguez
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  4. Lewis Lipsitz
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  5. Karen Chahal
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  6. Ara Nazarian
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Contributions

A. Nguyen conceptualized the Correspondence, provided scientific input, prepared the original figure, supervised, wrote the manuscript, and revised and approved the manuscript. P.M.L. prepared the original figure, wrote the manuscript, and revised and approved the manuscript. E.K.R., L.L. and K.C. conceptualized the Correspondence, provided clinical input, and revised and approved the manuscript. A. Nazarian conceptualized the Correspondence, provided input, supervised, revised, and approved the manuscript.

Corresponding author

Correspondence to Ara Nazarian.

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The authors declare no competing interests.

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Nature Aging thanks Carmelinda Ruggiero and Jae-Young Lim for their contribution to the peer review of this work.

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Nguyen, A., Lee, P.M., Rodriguez, E.K. et al. A phase-of-care approach to improve geriatric fracture care. Nat Aging (2025). https://doi.org/10.1038/s43587-025-00974-3

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