🏅Your Path to Certification
Earn your way up three evidence-based tiers. Each builds on the last. Finish all three and receive your Certified Prepared Patient · Hip Fracture badge and printable certificate, recognized across the FFH Network.
Aware · Identity: Self-Advocate
You know your body and your condition. Layer 1 — Condition Literacy.
- Complete Modules 1–4 (Condition Literacy)
- Pass the "What a Hip Fracture Is" quiz (≥80%)
- Identify your fracture pattern (femoral neck / intertrochanteric / subtrochanteric), your procedure done (hemi / THA / SHS / IM nail), your weight-bearing status, your ASA score, your baseline functional status, your T-score / FRAX for secondary prevention, your MoCA baseline (delirium-risk dial), your medication audit (Beers Criteria), and your relationship to the Ortho-Geriatric Co-Management team
- Build your one-page numbers card + weight-bearing log + pain log + CAM delirium screen (daily during in-hospital + SNF/IRF) + PHQ-9 weekly + falls + near-falls calendar + medication-adherence tracker (DVT prophylaxis + pain regimen + bone-health medication)
Active · Identity: Care Team Member
You partner with your team and navigate the system. Layer 2 — Care & System Literacy.
- Complete Modules 5–7 (Self-Monitoring · When to Call vs ED · Comorbidity Awareness)
- Demonstrate teach-back on your weight-bearing status, your multimodal pain regimen (acetaminophen scheduled + opioids sparingly + nerve block; NO benzos or anticholinergics), your bone-health medication (zoledronic acid IV per HORIZON RFT or alendronate/denosumab post-discharge), the absolute rule of never discontinuing denosumab without transition, and your "when to call vs ED" decision rule (DVT/PE / second fall with suspected fracture / surgical site infection / hypocalcemia tetany / cauda equina → ED; post-op delirium / fever / hardware concerns / missed denosumab / prodromal thigh pain → same-day call)
- Complete one "great visit" prep + debrief with your Orthopedic Surgery, Geriatric Medicine (CoCare:Ortho), PCP, or PT team across each transition (hospital → SNF/IRF → community)
- Establish PT (in-hospital + SNF/IRF + community) + OT (home safety + adaptive equipment) + Pharmacist (Beers Criteria audit + DVT prophylaxis + multimodal pain + bone-health initiation timing) + Social Work (SNF/IRF placement); pre-discharge bone-health workup (T-score / FRAX / 25-OH-D) + secondary-cause workup completed
- Successfully resolve one prior auth (e.g., for denosumab, teriparatide, abaloparatide, romosozumab), SNF/IRF placement decision, manufacturer copay-program application, or BHOF Helpline insurance-navigation issue
Certified Prepared Patient · Identity: Ambassador
You teach, mentor, fight stigma, and shape research & policy. Layer 3 — Advocacy & Ambassadorship.
- Complete Modules 8–10 (Family & Care Team · Talk to Kids/Partner/Employer + Mentor · Mastery & Graduation)
- Mentor 1 newly-injured hip-fracture survivor or family via the BHOF peer-mentor program (post-fracture recovery focus) / NOF Generations of Strength / International Osteoporosis Foundation / your hospital's patient-mentor program, OR present at a faith-community / employer / school / senior center / BHOF chapter education session about the falls cascade and post-fracture treatment-gap rescue
- Sign the Prepared Patient Pledge
- Complete a written advance care plan for advanced hip-fracture recovery (code status, hospice criteria, mobility planning, healthcare proxy) AND a Caregiver Layer / Skills Lab Fall Prevention at Home module with your family Ambassador (the walk-the-house fall-prevention sweep is the bridge skill module)
- Submit one advocacy action (story, Bone Health Day May 24 or World Osteoporosis Day Oct 20 outreach, state-level Geriatric-Co-Management adoption advocacy, HEDIS post-fracture treatment-initiation tracking, AA mortality-disparity outreach, male undertreatment outreach, LGBTQ+ placement-discrimination outreach, RRPS Certification enrollment, post-fracture treatment-gap rescue stories)
📋Master Pre / Post Assessment
Where You Stand — Confidence Before & After
Seven dimensions of being a Prepared Patient. Answer once at the start of your journey and again at the end. Your goal is to see real growth across understanding, self-management, communication, and optimal utilization — knowing when to call your team, when an issue can wait for clinic, and when to go to the ER. Your answers stay on this device unless you choose to share with your clinician.
📈 Your Pre→Post Growth
📞Know Who to Call — Ortho / Geriatrics First, ED for Red Flags
Hip-fracture recovery runs across hospital → SNF/IRF → community. Most days are steady. Some days bring medication-adherence or PT-progress calls. A few bring red flags. Knowing the right number — your Orthopedic Surgery / Geriatric Medicine team, your PCP, the BHOF Helpline, or 911 / ED — saves time, dignity, and fractures. Save these numbers in your phone today. The numbers below are placeholders — your institution will fill in the right ones for you.
🚑 Go to the ED right away for any of these
DVT or PE symptoms (calf swelling/warmth/pain, sudden shortness of breath, pleuritic chest pain, tachycardia — PE is a major post-op killer) · surgical site infection (increasing redness, drainage, fever, severe wound pain or instability) · second fall with suspected fracture (hip/groin/thigh pain + can't bear weight; don't walk; call EMS) · severe chest pain (MI, PE) · severe shortness of breath (pneumonia, PE, heart failure) · sudden severe back pain (vertebral fragility fracture) · cauda equina symptoms (severe back pain + new weakness/numbness/bowel/bladder incontinence — surgical emergency) · hypocalcemia tetany after IV bisphosphonate or denosumab (tingling around mouth, hand cramps) · stroke-like symptoms (BE-FAST) · active suicidal intent or attempt (988 or 911 / ED). When in doubt, go.
🧭 Same-day call to your bone-health team — most things are addressable in clinic, not the ED
For post-op delirium (CAM-positive — first sign of UTI / pneumonia / medication issue post-op; family Ambassador often spots first — DO NOT sedate; find the reversible cause), fever (rule out pneumonia / UTI / SSI), increasing pain unresponsive to multimodal regimen, hardware concerns (clicking, dislocation symptoms, leg-length change), missed denosumab Q6-month dose (rebound vertebral fracture risk — must transition or reschedule), prodromal thigh / groin / hip pain on long-term bisphosphonate (atypical femoral fracture warning), severe GI side effects on oral bisphosphonate, PHQ-9 ≥10 (post-fracture depression is real and treatable), call your [Ortho line / Geriatric Medicine: (555) 123-4567]. Most issues are addressable in clinic.
💬 Routine questions, refills, scheduling, peer support
Use [MyChart portal] first — most messages answered within 1 business day. For DVT prophylaxis, multimodal pain regimen, anti-resorptive/anabolic adherence, or copay questions, call [Pharmacy: (555) 222-9050]. For post-fracture bone-health navigation + peer mentoring (post-fracture recovery focus) + family support, call the Bone Health & Osteoporosis Foundation Helpline 1-800-231-4222. For NIH-curated patient information, NIH NIA 1-800-222-2225. For AA / Latina / Asian / LGBTQ+ / rural / veteran communities: BHOF chapters and AGS resources offer culturally-affirming groups; AGS americangeriatrics.org for geriatric care advocacy.
🆘 Mood crisis · suicidal thoughts → 988 (call or text)
Post-fracture depression is real (~20–30% incidence) and treatable. Depression doubles fracture risk independently. Any thoughts of wanting to die or hurt yourself = call or text 988 (Suicide & Crisis Lifeline · free, confidential, 24/7). Active risk → 911 / ED. Veterans: 988 then press 1. Crisis Text Line: text HOME to 741741. Asking about suicide does not plant the idea. Some SSRIs raise fracture risk modestly but treated depression lowers it net — sertraline and escitalopram are osteoporosis-aware choices; AVOID amitriptyline (anticholinergic; falls + delirium + cognition).
📚Condition Literacy & the 10 Prepared Patient Competencies
A Prepared Patient builds three kinds of health literacy — and grows into three identities. Each competency works through the FFH three pillars: Learn It · Live It · Share It.
Advocate for Self
You speak up for your own care, plan, pain, and goals.
Care Team Member
You partner with your team — not above, not below.
Ambassador
You teach, mentor, and shape research, policy & access.
🧬 Condition Literacy Learn It · Tier 1 Aware
"I know my body and my disease." The foundation. Without this, nothing else holds.
What Osteoporosis Is
A silent bone disease — bone mineral density (BMD) and microarchitecture quality drop until ordinary loads cause a fragility fracture (wrist, spine, hip, shoulder). About 10M Americans have osteoporosis; another ~44M have osteopenia. 1 in 2 women and up to 1 in 4 men over 50 will fracture in their remaining lifetime. Highly modifiable at any age. What osteoporosis is NOT: osteoarthritis (joint cartilage disease), osteomalacia (defective mineralization), Paget's disease (focal disordered remodeling), or normal aging.
Know My Numbers & Risk Factors
Your hip-fracture dashboard: ASA score, baseline functional status (ADLs/IADLs/gait speed; gait speed <0.6 m/s = severe limitation), comorbidities, anticoagulation, T-score / FRAX (for secondary prevention), MoCA baseline (delirium-risk dial), medication audit (Beers Criteria — anticholinergics, sedatives, antihypertensives, fall-risk meds), vitamin D + albumin, weight / BMI, orthostatic BPs. Risks: age 70+, osteoporosis (upstream cause), falls, prior fragility fracture, female sex, low BMI, sarcopenia, vision/hearing impairment, polypharmacy, dementia (2× fall risk), PD (2–3× hip-fracture risk), stroke, frailty, vitamin D deficiency, glucocorticoids, AI / ADT survivorship, CKD-MBD, T2D paradox. Family hx parental hip fracture ≈ doubles risk. AA hip fracture mortality > white — access/co-management/IRF/bone-health gaps.
Lifestyle Force Field — Recovery + Prevention
Early mobilization within 24 hours post-op (PT-guided weight-bearing as tolerated — most modern surgeries permit this). Protein 1.2–1.5 g/kg/day (recovery substrate; older adults often protein-undernourished). Calcium 1,000–1,200 mg/day from food first + Vitamin D 800–1,000 IU; correct deficiency before IV antiresorptive. Fall prevention — home sweep, footwear, vision/hearing, med audit; RRPS Certification bridge + Caregiver Layer / Skills Lab Fall Prevention at Home. Resistance + balance training (Otago program; tai chi RCT-proven). Treat post-fracture depression (~20–30% incidence — PHQ-9 weekly first 12 weeks). Sleep, smoking cessation, alcohol moderation, cognitive engagement.
Medications — Anticoagulation, Pain Balance, Bone-Health Initiation
DVT prophylaxis (enoxaparin / apixaban / rivaroxaban / aspirin × 10–35 days). Multimodal pain control: scheduled acetaminophen + opioids sparingly + pre-op fascia iliaca / femoral nerve block. AVOID benzodiazepines + anticholinergics (drive delirium). Bone-health initiation BEFORE discharge per HORIZON RFT: zoledronic acid IV 2 wk–3 mo post-hip-fracture reduces 2nd fracture 35% AND mortality 28% — landmark trial. Or alendronate/denosumab post-discharge. Correct vitamin D + calcium + hypocalcemia first. NEVER discontinue denosumab without transition (rebound vertebral fractures). Beers Criteria audit with pharmacist. For PD patients: NEVER stop dopamine meds abruptly perioperatively (NMS-like syndrome).
🤝 Care & System Literacy Live It · Tier 2 Active
"I'm part of the team. I navigate the system." Where most preventable ED visits, decompensation crises, and frustration happen — and where this course pays off the most. Optimal utilization lives here.
Self-Monitoring — Mobility, Pain, Function, Falls, Mood
Recovery is active work; the numbers card travels. Weight-bearing status + mobility milestones (sit-to-stand → transfer → walker → cane → unassisted → stairs). Pain score 0–10 (target <4 with activity on multimodal). CAM delirium screen daily during in-hospital + SNF/IRF stays — family Ambassador can run. FIM or Barthel Index at rehab admission + discharge. Falls + near-falls calendar (clusters predict next fall). PHQ-9 weekly first 12 weeks (post-fracture depression 20–30%). Medication-adherence tracker. Constipation tracker on opioids. 30/90/365-day milestones: ambulation, pain, return-to-function, bone-health, 2nd fracture, mortality.
When to Call vs Go to ED — Post-Op + Recovery Red Flags
ED: DVT/PE symptoms (calf swelling, SOB, pleuritic CP); surgical site infection; second fall with suspected fracture (don't walk); severe chest pain or SOB; sudden severe back pain (vertebral fragility fracture); cauda equina symptoms; hypocalcemia tetany; stroke-like (BE-FAST). Same-day call: post-op delirium (CAM-positive — find reversible cause; don't sedate); fever; pain unresponsive to multimodal; hardware concerns; missed denosumab dose; prodromal thigh pain on long-term bisphosphonate; PHQ-9 ≥10. Mood crisis → 988 (post-fracture depression 20–30%).
Comorbidity Awareness — The Fragility-Fracture Cascade & Recovery Ecosystem
Hip-Fracture-specific Module 7. Frame: the fragility-fracture cascade — upstream causes, downstream sequelae. Osteoporosis course (upstream cause; close the post-fracture treatment gap per HORIZON RFT). RRPS Certification (prevention layer; 5 of 16 cards falls-themed). Falls / Sarcopenia / Orthostatic Hypotension / Vestibular Journeys. Delirium-on-Dementia overlap (CAM mandatory; AVOID benzos + anticholinergics). Post-fracture depression (Sprint 6 Depression / Anxiety; 988). Parkinson's (2–3× hip-fracture risk; never abrupt dopamine cessation). Stroke, CKD-MBD, cirrhosis, T2D paradox, cancer survivorship. Vascular cluster (md5 7587a559b24ca8b9bab40b1756475d84) cross-referenced, NOT embedded.
📣 Advocacy & Ambassadorship Share It · Tier 3 Certified
"I speak up. I lift others. I shape the future." This is what turns a Prepared Patient into a force multiplier for the whole community.
Family, Caregiver, and Care Team — Surgery-to-Home Continuum Navigator
The surgery-to-home continuum navigator. Daily CAM delirium-watch in-hospital + SNF/IRF (family Ambassador can run). Adherence partner (DVT prophylaxis + multimodal pain + bone-health medication + chronic meds). Appointment partner across every transition. Post-fracture treatment-gap rescuer — SINGLE highest-leverage Ambassador task (insist on bone-health plan BEFORE discharge per HORIZON RFT). Walk-the-house fall-prevention sweep before return — Caregiver Layer / Skills Lab Fall Prevention at Home bridge module. Mood watch (PHQ-9 weekly first 12 weeks). Care team: Ortho + Geriatrics (CoCare:Ortho) + PCP + Anesthesia + PT + OT + Pharmacist + SW + BH + Nutrition + Endo + Nephro + Onco + BHOF peer + Ambassador + RRPS. Caregiver-PHQ-9 + respite.
Sharing — Talk to Family, Equity Ambassador for AA Mortality + Men
Adult children: recovery-trajectory navigator + Ambassador team. Partner: continuum navigator + daily CAM + adherence + walk-the-house sweep. Family hx parental hip fracture ≈ doubles FRAX risk — tell adult children/siblings. Equity Ambassador for AA mortality disparity (advocate for ortho-geriatrics co-management + IRF + bone-health follow-up). Equity Ambassador for male under-treatment (<20% start bone medication post-hip-fracture). LGBTQ+ placement discrimination — bring Ambassador. Veterans VA pathway. Rural access gaps + telehealth follow-up. Limited-English-proficiency: qualified interpreters mandatory. ADA + FMLA + SSDI. BHOF peer-mentor + RRPS Certification bridge.
Mastery & Graduation — Sustained Engagement, Peer Mentor, Long-Arc Identity
Sustained recovery + second-fracture prevention. Daily: mobility + nutrition + medication. Weekly: 2–3 resistance + 2–3 balance + walking. 6–12-month: PHQ-9 + Beers Criteria re-audit. Yearly: bone-health follow-up, DXA cadence. Peer mentorship via BHOF (post-fracture recovery focus) + NOF Generations of Strength + International Osteoporosis Foundation + Bone Health Day (May 24) + World Osteoporosis Day (Oct 20). RRPS Certification bridge. Advocacy: Geriatric-Co-Management adoption; HEDIS post-fracture treatment-initiation tracking; AA mortality disparity; male undertreatment; LGBTQ+ placement; rural / SNF disparities. Advance care planning for advanced recovery. Long-arc identity: hip fracture happened; you are a Prepared Patient for life. Earn Certified Prepared Patient · Hip Fracture.
👥My Care Team
Your team is bigger than just the doctor — and the care partner is part of it. Click any card to edit, or click the + tile to add a new team member. Saved on this device. The Force Field Emergency Card below auto-syncs from this list. Starter roster pre-populated for Hip Fracture — your institution can edit any row. The Force Field Emergency Card auto-syncs from this list and surfaces the BHOF Helpline + the "NEVER MISS A DENOSUMAB DOSE" rule + the post-fracture treatment-gap rescue checklist + the CAM delirium screen + the AVOID-benzos-and-anticholinergics rule.
📖Glossary — words you'll hear
Plain-English definitions for terms doctors and labs use. Tap to expand.
Fragility fracture
Femoral neck fracture
Intertrochanteric fracture
Subtrochanteric fracture
ASA Physical Status Classification
Geriatric Co-Management (CoCare:Ortho)
CAM (Confusion Assessment Method)
HORIZON Recurrent Fracture Trial (RFT)
Post-fracture treatment gap
Beers Criteria
Fascia iliaca / femoral nerve block
FIM / Barthel Index
Denosumab (Prolia)
🧪Screen & Lab Tutor — your ASA, MoCA, T-score, Beers Criteria, and what your hip-fracture workup means
Screen & Lab Tutor — your ASA, MoCA, T-score, Beers Criteria, and what your hip-fracture workup means
In hip-fracture care, the most important "labs" are your ASA score, baseline functional status, MoCA cognition (delirium-risk dial), T-score / FRAX (secondary prevention), Beers Criteria med audit, vitamin D, and albumin. Your "normal" may be different from a friend's. Ask your team to write your personal baseline in the column on the right.
| Test / Screen | What it measures | Typical adult range | What to ask if it's off | My baseline |
|---|---|---|---|---|
| ASA Physical Status | Anesthetic-risk score I (healthy) → V (moribund). Drives pre-op planning + risk discussion. | Most older adults: ASA II–III | What is my ASA? How does it affect surgery planning? | [fill in] |
| Baseline functional status | ADLs (bathing, dressing, transferring, feeding); IADLs (cooking, finances, transport, medication); ambulation distance; gait speed. Sets recovery target. | Gait speed ≥1.0 m/s good; <0.6 m/s severe limitation | What was my baseline? What is the recovery target? | [fill in] |
| MoCA cognitive baseline | Montreal Cognitive Assessment — 30-point screen. Sets the post-op delirium-risk dial. Lower MoCA = higher delirium risk. | ≥26 normal · 18–25 MCI · <18 likely dementia (rough guide) | What is my MoCA? Should we plan more aggressive delirium prevention? | [fill in] |
| T-score (DXA) | Bone mineral density vs healthy young adult. Drives post-fracture treatment-gap rescue. | ≥ -1.0 normal · -1.0 to -2.5 osteopenia · ≤ -2.5 osteoporosis | Was DXA done pre-discharge? Bone-health plan initiated? | [fill in] |
| FRAX 10-yr probability | WHO Fracture Risk Assessment Tool. Major-osteoporotic + hip 10-yr probabilities. | US treat: ≥20% major or ≥3% hip | What is my FRAX? Above treat threshold? Recalc each visit. | [fill in] |
| 25-OH Vitamin D | Vitamin D level. Required adequate before IV bisphosphonate / denosumab. Recovery substrate. | Target ≥30 ng/mL · Insufficient 20–29 · Deficient <20 | What is my 25-OH-D? Correction plan if deficient? | [fill in] |
| Serum calcium + albumin · iPTH | Calcium homeostasis. Hypocalcemia MUST be corrected before denosumab or IV bisphosphonate. | Ca 8.5–10.5 mg/dL (corrected) · iPTH 10–65 pg/mL · Alb ≥3.5 g/dL | Albumin (protein adequacy)? Hypocalcemia corrected? | [fill in] |
| CBC, BMP, coagulation, ECG, type-and-screen | Standard pre-op workup. Anticoagulation review key. | Within reference range or addressed | Is my anticoagulation reversed/held appropriately? Type-and-screen ready? | [fill in] |
| Beers Criteria med audit | AGS list of potentially inappropriate medications in older adults — anticholinergics, sedatives (especially benzos), antihypertensives causing orthostasis, fall-risk meds. | Reviewed + deintensified where possible | Has my med list been audited? Can any be stopped or reduced? | [fill in] |
| CAM Delirium Screen (daily during stay) | 4 questions: (1) acute onset / fluctuating (2) inattention (3) disorganized thinking (4) altered LOC. Family Ambassador can run. | Negative; CAM-positive = same-day call | If CAM-positive — find reversible cause (UTI, pneumonia, meds, pain, dehydration). Don't sedate. | [fill in] |
| Pain score (0–10) + multimodal regimen | Target <4 with activity on multimodal. AVOID benzodiazepines and anticholinergics for pain/sleep/anxiety. | 0–10 numeric; multimodal regimen | Is my pain regimen multimodal (acetaminophen + opioid sparingly + nerve block)? | [fill in] |
| FIM or Barthel Index | Functional Independence Measure or Barthel Index at rehab admission + discharge. Tracks ADL recovery. | Higher = more independent | What is my FIM/Barthel trend? Discharge target? | [fill in] |
| PHQ-9 (weekly first 12 weeks) | Depression screen. Post-fracture depression ~20–30% incidence. Treating mood is recovery work. | <5 minimal · 5–9 mild · 10–14 moderate · ≥15 mod-severe | If ≥10 — call team. Osteoporosis-aware SSRI (sertraline, escitalopram). AVOID amitriptyline. | [fill in] |
➕Add-On Modules & Earnable Badges
Stackable modules that match your situation. Complete one to earn an extra badge on your certificate. Your institution can add their own.
🚶 Weight-Bearing Progression Routine
PT-guided weight-bearing as tolerated. Sit-to-stand → transfer → walker → cane → unassisted → stairs. Pain <4/10 with activity on multimodal. Log distance daily.
💉 DVT Prophylaxis Schedule
Enoxaparin / apixaban / rivaroxaban / aspirin × 10–35 days post-op. Set phone reminder. Watch for calf swelling, sudden SOB — ED if symptoms.
🧠 Delirium-Prevention Protocol (CAM Daily)
Reorientation + sleep hygiene + minimizing tethers (Foley / restraints) + minimizing sedatives + family presence. Family Ambassador runs CAM daily. CAM-positive = same-day call.
💊 Multimodal Pain-Management Routine
Scheduled acetaminophen (1 g q6h) + opioids sparingly (low dose, taper) + pre-op fascia iliaca / femoral nerve block. AVOID benzodiazepines + anticholinergics (drive delirium). Stool softeners on opioids.
🍳 Protein-Adequate Nutrition Routine
1.2–1.5 g/kg/day. Eggs, dairy, fish, poultry, legumes; protein shakes if needed. Older adults often protein-undernourished post-fracture. Combined with PT-guided resistance, protein supports recovery.
🦴 Bone-Health Initiation BEFORE Discharge (HORIZON RFT)
Zoledronic acid 5 mg IV started 2 wk–3 mo post-hip-fracture reduces 2nd fracture 35% and mortality 28% (HORIZON RFT). Or alendronate / denosumab post-discharge. Vitamin D + calcium adequacy first; correct hypocalcemia. Single highest-leverage post-fracture task.
🏠 Walk-the-House Fall-Prevention Sweep Before Return
Caregiver Layer / Skills Lab Fall Prevention at Home module is the bridge skill module. Clear hazards, lights, grab bars, footwear, vision/hearing.
🏥 SNF / IRF / Home Decision Checklist
SNF: Medicare Part A covers 100 days (1–20 full; 21–100 copay) after qualifying 3-night admission. IRF: requires 3 hr/day therapy × 5 d/wk. Home health: home-bound + skilled need. Social work navigates.
👨👩👧 Family-Ambassador Surgery-to-Home Continuum Role
Daily CAM. Adherence partner. Appointment partner. Post-fracture treatment-gap rescuer. Walk-the-house sweep. PHQ-9 weekly. Numbers card travels.
🛡️ RRPS Fall-Prevention Certification Bridge
Risk Reduction & Prevention Specialist Certification — 5 of 16 cards falls-themed. Graduates of this course are natural candidates for community fall-prevention work.
🗓️ Secondary-Prevention Bone-Health Follow-Up Routine
Bone-health medication adherence indefinitely (unless drug-holiday window). DXA + FRAX cadence. Falls vigilance. The next fracture is what we are preventing.
📓 Advance Care Planning
For severe hip fracture or older very-frail patients: code status, hospice criteria, mobility planning, healthcare proxy. Conversation with family + healthcare proxy designated.
🧪 In a Hip-Fracture Clinical Trial?
Protocol literacy, side-effect tracking, when to call the study coordinator vs your usual team. Trials currently exploring novel anti-resorptive sequencing, Geriatric Co-Management models, delirium-prevention bundles. Search ClinicalTrials.gov.
+ Add Your Institution's Module
Drop in your own — local BHOF chapter, senior-center fall-prevention program, AAOS hip-fracture pathway, AGS CoCare:Ortho local protocol, faith-community partnership, employer wellness program, ortho or geriatrics rotation.
🛡️Force Field Emergency Card
🛡️ Force Field Emergency Card FRIDGE · WALLET · EMT-READY
A one-page emergency record for any EMT, ER, new doctor, or transition visit. Print one for the fridge, one for your wallet. Updates anytime. This is the document you hand to a stranger when you can't speak for yourself. Pair with the BHOF Helpline (1-800-231-4222) and the post-fracture treatment-gap rescue checklist.
🤝 My Care Team — call list for any clinician picking up my care
📘My Health Passport
📘 My Health Passport PATIENT-OWNED JOURNAL
This is your record — not your hospital's. Log every visit, capture every question for next time, and watch your own trends. Many of you get care at more than one hospital, on more than one record system. This Passport travels with you. Future versions will let you import data directly from your patient portals (the "Blue Button" vision).
🩺Working With a Prepared Patient · Hip Fracture
Your patient is going through a structured, evidence-based course. Here's how to get the most out of every visit, reduce delirium and post-fracture treatment-gap drift, support the family Ambassador (especially the surgery-to-home continuum + delirium-watch + adherence + walk-the-house fall-prevention partner roles), and partner well across the long hip-fracture recovery arc (hospital → SNF/IRF → community). Built on the AHRQ SHARE Approach, IOM teach-back, alignment with AAOS, the American Geriatrics Society (AGS) and CoCare:Ortho, the HORIZON Recurrent Fracture Trial (zoledronic acid IV post-hip-fracture), the BHOF for post-fracture treatment-gap closure, the AGS Beers Criteria, and the CAM delirium screen. The BHOF Helpline (1-800-231-4222) and Geriatric Co-Management resources are surfaced throughout.
The SHARE Approach — your 5-step playbook
Use these steps in any order. Cycle back. Use teach-back at every transition. Source: AHRQ Pub. No. 25-0005 (Oct 2024).
💬Teach-Back & Risk Communication
The two highest-yield, lowest-cost SDM techniques. Use both at every visit.
🔁 Teach-Back (1–2 min)
- "Just so I know I explained it well — what would you tell your family Ambassador about your weight-bearing status? About the multimodal pain regimen (no benzos, no Benadryl)? About when to call me vs the ED after a fall or post-op? About the bone-health medication we started?"
- Open-ended ("what" / "how"), not yes/no.
- If they get it wrong: "I must not have explained it well — let me try a different way." Then teach-back again.
- Use it for: weight-bearing status (sit-to-stand → transfer → walker → cane → unassisted → stairs); multimodal pain regimen (scheduled acetaminophen + opioids sparingly + nerve block; NO benzos / NO Benadryl); HORIZON RFT bone-health initiation (zoledronic acid IV 2 wk–3 mo post-hip-fracture reduces 2nd fracture 35% + mortality 28%); delirium-prevention (CAM daily; AVOID benzos + anticholinergics; treat reversible causes); fall-with-suspected-fracture rule (don't walk on it — ED); post-fracture treatment-gap rescue rule (don't leave the hospital without a plan); when to call vs ED.
- Document teach-back in your note — it's a quality measure and a billable element of care.
🔢 Communicating Numbers
- Use absolute risk, not relative. "15 to 20 of every 100" beats "15–20%" beats "fairly common" beats "low risk."
- Keep denominators & timeframes constant when comparing options.
- Show, don't tell: icon arrays, photographs of dyskinesia vs tremor, written summary.
- For recovery-trajectory numbers: give the trend, not just the value. "Your gait speed was 0.5 m/s pre-fracture and is 0.7 m/s at 12 weeks. Your FIM at IRF admission was 75 and at discharge was 95. Your CAM was negative throughout. We can discuss continued community PT vs graduation, and confirm the bone-health medication for second-fracture prevention."
⚠️Hip-Fracture-Specific Clinical Guardrails
Recognition + Pre-Op Pathway
- Recognition: hip / groin / thigh pain after a fall + inability to bear weight + leg shortened/rotated = hip fracture until proven otherwise. Mechanism may be minor or absent in osteoporotic patient.
- Do NOT walk on a possibly fractured hip — displacement worsens surgical decisions and may disrupt vascular supply.
- X-ray may miss occult fractures — if clinical suspicion high and X-ray negative, MRI is the next step.
- Standard pre-op workup: CBC, BMP, coagulation, ECG, CXR, type-and-screen, anticoagulation review.
- Pre-op fascia iliaca or femoral nerve block reduces opioid requirement + post-op delirium.
- Geriatric Co-Management (CoCare:Ortho) consult in ED if available — evidence-based; lower delirium, shorter LOS, better functional recovery.
Surgical Pathway
- Same-day or next-day surgery (within 24–48 hr) = standard. Each 24-hr delay raises mortality + complications.
- Displaced femoral neck (older adult) → hemiarthroplasty or total hip arthroplasty (THA); THA gives better functional outcomes in active patients.
- Non-displaced femoral neck (younger) → percutaneous cannulated screws.
- Intertrochanteric → sliding hip screw (SHS/DHS) or cephalomedullary nail.
- Subtrochanteric → cephalomedullary nail; consider atypical femoral fracture in older long-term bisphosphonate users.
- Spinal vs general anesthesia: comparable mortality in modern trials; spinal may reduce delirium in some.
- Anticoagulation reversal/holding per drug protocol (warfarin: vit K + FFP/4F-PCC; DOACs held; idarucizumab for dabigatran if bleeding).
Post-Op Recovery
- Early mobilization within 24 hr — most modern fixation permits weight-bearing as tolerated. Bedrest is harmful (DVT, atelectasis, deconditioning, delirium, pressure ulcers).
- DVT prophylaxis × 10–35 days post-op (enoxaparin / apixaban / rivaroxaban / aspirin per protocol).
- Multimodal pain control: scheduled acetaminophen + opioids sparingly + regional block. AVOID benzodiazepines + anticholinergics (drive delirium). NSAIDs cautiously in older adults.
- Delirium prevention: CAM daily; reorientation; sleep hygiene; minimize tethers (Foley, restraints) and sedatives; family presence. CAM-positive = find reversible cause (UTI, pneumonia, undertreated pain, medication, dehydration); don't sedate.
- Nutrition: protein 1.2–1.5 g/kg/day; vitamin D + calcium adequacy.
Bone-Health Initiation BEFORE Discharge (HORIZON RFT)
- HORIZON Recurrent Fracture Trial (Lyles et al, NEJM 2007): zoledronic acid 5 mg IV started 2 weeks to 3 months after hip-fracture repair reduced 2nd fracture by 35% AND mortality by 28%. Initiate before discharge whenever feasible.
- Alternatives: alendronate or denosumab post-discharge.
- Correct hypocalcemia + vitamin D deficiency BEFORE denosumab or IV bisphosphonate.
- NEVER discontinue denosumab without transition to a follow-on antiresorptive — rebound vertebral fractures.
- Anabolics (teriparatide, abaloparatide, romosozumab) for severe / very-high-risk; romosozumab contraindicated within 1 yr of MI/stroke.
The Hip-Fracture "NEVER" / "ALWAYS" List
- NEVER walk on a possibly fractured hip.
- NEVER use benzodiazepines for sleep/anxiety post-op in older adults (drive delirium).
- NEVER use anticholinergics (diphenhydramine for sleep, oxybutynin for urgency) — use non-anticholinergic alternatives.
- NEVER stop dopamine medications abruptly perioperatively in PD patients (NMS-like syndrome).
- NEVER discontinue denosumab without follow-on antiresorptive (rebound vertebral fracture risk).
- NEVER start denosumab or IV bisphosphonate in hypocalcemia — correct first.
- ALWAYS consult Geriatric Co-Management if available.
- ALWAYS initiate bone-health medication before discharge (HORIZON RFT).
- ALWAYS run CAM daily during in-hospital and SNF/IRF stays.
- ALWAYS audit polypharmacy via Beers Criteria.
- ALWAYS close the post-fracture treatment gap.
Quality Metrics for a Prepared Patient · Hip Fracture
- Time-to-surgery within 24–48 hr; Geriatric Co-Management uptake; CAM-positive rate (and reversible-cause workup completion); length of stay; placement matching; functional recovery (FIM/Barthel + return-to-prior-functional-level); post-fracture treatment-initiation rate (HEDIS — target ≥80% within 6 months); 2nd fracture rate; 30/90/365-day mortality.
- Equity tracking: outcomes by race/ethnicity/sex/rural-urban/insurance — close the AA mortality + male undertreatment gaps.
🌍Equity, Cultural Competence & Trust
Hip fracture has well-documented access and outcome gaps. AA hip-fracture rates are LOWER than white but mortality is HIGHER — driven by access to orthopedics + geriatrics co-management, IRF placement, and post-discharge bone-health care. Rural patients face access gaps to high-volume hip-fracture centers (volume associated with better outcomes) and to IRFs. Low-income patients have SNF placement disparities (Medicaid harder than Medicare). LGBTQ+ older adults may face discrimination in SNF/IRF placement. Men with hip fracture are massively undertreated for secondary fracture prevention (<20% start bone medication, vs ~30% of women — both inadequate but men worse). Native American and Native Hawaiian / Pacific Islander populations face under-studied geriatric care gaps. Veterans with hip fracture have a VA pathway. Limited-English-proficiency patients face hand-off and consent gaps. Repair starts in your office.
- Insist on Geriatric Co-Management referrals for ALL older hip-fracture patients — close the access gap.
- Track post-fracture treatment-initiation rate by race/sex — HEDIS metric. Close the AA + male gaps.
- Match the messenger when possible: peer mentors via BHOF chapters (post-fracture recovery focus), NOF Generations of Strength, community health workers.
- Use qualified medical interpreters — never family, never minor children. Hip-fracture conversations (surgical consent, anticoagulation, post-op delirium-prevention, advance care planning) must be in the patient's primary language.
- Invite the family Ambassador in with patient consent. The surgery-to-home continuum navigator + daily CAM delirium-watch + adherence + walk-the-house fall-prevention sweep roles are real medicine.
- Telehealth closes rural and equity gaps for ortho + geriatrics + PT follow-up — advocate for parity coverage.
- Men with hip fracture: actively screen for secondary fracture prevention. <20% start bone medication — close that gap.
- LGBTQ+ older adults: SNF/IRF placement discrimination is real — advocate; family Ambassador present at placement meetings.
- Mood crisis resources: 988 (call or text), 741741 (text HOME), 988 then press 1 for veterans. Post-fracture depression doubles 1-yr mortality if untreated.
🏥Customize for Your Institution
Clone this course and replace the highlighted blocks with your own information. Each editable field below is a placeholder — change it once and it propagates through the patient view.
📞 What Should Replace the When-to-Call Block
- Orthopedic Surgery 24/7 on-call / triage line
- Geriatric Medicine / CoCare:Ortho on-call
- Bone Health & Osteoporosis Foundation Helpline 1-800-231-4222 M–F (for post-fracture bone-health navigation)
- NIH NIA 1-800-222-2225
- Hip-fracture-aware pharmacy line (DVT prophylaxis, multimodal pain, bone-health initiation, copay programs)
- PT clinic (in-hospital + SNF/IRF + community) + OT (home safety)
- Social Work / Case Manager (SNF/IRF placement; insurance navigation)
- Behavioral Health (post-fracture depression)
- Mood crisis: 988 (call or text) · 741741 (text HOME) · 988 then press 1 Veterans
- Patient portal login URL with Ambassador proxy
👤 Who Is Your Ortho-Geriatrics Care Navigator?
- Name, role, photo, scheduling link.
- What teach-back / check-ins they own (weight-bearing status review, multimodal pain plan, CAM delirium screen, bone-health initiation timing per HORIZON RFT, post-fracture treatment-gap rescue checklist, walk-the-house fall-prevention sweep, advance care planning, caregiver wellness).
- How patients and Ambassadors reach them between visits / across transitions.
- How they handle SNF/IRF placement navigation, prior-auth (denosumab, anabolics, IV zoledronic acid scheduling), and bone-health follow-up scheduling.
📚 Add Your Own Modules
- Your hip-fracture clinical trial protocols (CoCare:Ortho effectiveness, novel delirium-prevention bundles, post-fracture treatment-gap interventions — link to ClinicalTrials.gov).
- Your Geriatric Co-Management (CoCare:Ortho) protocol — process, team, outcomes tracking.
- Your in-hospital PT + SNF/IRF + community-PT partner network.
- Local peer support partners (BHOF chapter post-fracture-recovery focus · senior-center programs · faith-community partnerships · RRPS-certified community members).
🎨 Re-skin in 2 Lines of CSS
--inst-primary: your brand color- Replace the FFH × AAOS · AGS × [Your Institution] cobrand in the hero
- Drop in your logo PNG (white version) — same 48px height as FFH logo
📚 Evidence Base — what this course is built on
- AHRQ SHARE Approach — 5-step shared decision making framework. AHRQ Pub. 25-0005, Oct 2024. ahrq.gov/sdm
- AHRQ Health Literacy Universal Precautions Toolkit (3rd ed.) — teach-back, plain language, accessible materials. AHRQ Pub. 23-0075, March 2024.
- AAOS · Management of Hip Fractures in Older Adults — clinical practice guideline.
- American Geriatrics Society (AGS) · CoCare: Ortho — Geriatric Co-Management model with evidence base for lower delirium, shorter length of stay, better functional recovery in hip-fracture patients.
- HORIZON Recurrent Fracture Trial (Lyles et al, NEJM 2007) — zoledronic acid 5 mg IV started 2 weeks to 3 months after hip-fracture repair reduced 2nd fracture by 35% and mortality by 28%. Foundational for the post-fracture treatment-gap rescue rule.
- Bone Health & Osteoporosis Foundation (BHOF) — Helpline 1-800-231-4222; Clinician's Guide; peer-mentor program with post-fracture recovery focus.
- NIH National Institute on Aging (NIA) — 1-800-222-2225; falls + fractures in older adults.
- AGS Beers Criteria — potentially inappropriate medications in older adults; identifies anticholinergics, sedatives, antihypertensives, fall-risk meds.
- CAM · Confusion Assessment Method — gold-standard bedside delirium screen; family-Ambassador-friendly.
- FIM / Barthel Index — functional outcome measures for rehab tracking.
- CDC STEADI · Stopping Elderly Accidents, Deaths & Injuries — fall-risk self-screen, Timed Up and Go, 30-second chair stand.
- Otago Exercise Program — RCT-proven 17-exercise PT-delivered fall reduction in older adults.
- Tai Chi for fall prevention — RCT evidence in older adults.
- National Hip Fracture Database (US/UK) — registries tracking time-to-surgery, geriatric co-management, mortality, and post-fracture treatment-initiation as quality metrics.
- 988 Suicide & Crisis Lifeline — call or text 988, free, confidential, 24/7. Crisis Text Line: text HOME to 741741. Veterans Crisis Line: 988 then press 1. Post-fracture depression (~20–30%) doubles 1-yr mortality if untreated.
- FFH Prepared Patient · Osteoporosis (upstream cause) — bidirectionally cross-referenced. Closing the post-fracture treatment gap requires the Osteoporosis-course framing.
- FFH Prepared Patient · Dementia / Alzheimer's — delirium-on-dementia overlap is huge post-op; cross-referenced from Module 7.
- FFH Prepared Patient · Depression and Anxiety — post-fracture depression cross-referenced from Module 7.
- FFH Prepared Patient · Parkinson's Disease — PD patients have 2–3× hip-fracture risk; NEVER abrupt dopamine cessation perioperatively.
- FFH RRPS · Risk Reduction & Prevention Specialist Certification — 5 of 16 cards falls-themed; the natural community-certification bridge for graduates of this course.
- FFH Caregiver Layer + Skills Lab Fall Prevention at Home — bridge skill module for family Ambassador.
- FFH Cluster Courses (HTN / T2D / CHF / CAD / post-MI / post-stroke / Alzheimer's / MS / brain tumor / cirrhosis / CKD) — the canonical comorbidity cluster module (md5 7587a559b24ca8b9bab40b1756475d84) is CROSS-REFERENCED from this Hip Fracture course's Module 7, NOT embedded or modified. Hip Fracture is not a cluster member; vascular comorbidities complicate perioperative outcomes.
- Force Field Fact Sheet · Hip Fracture — the 16-square primer (companion file). This deep course extends and operationalizes the fact sheet.
Course content is educational and not a substitute for medical advice from your own clinicians. Institutions cloning this course are responsible for accuracy of all customized blocks.