Fragility fracture audit is key to understanding fragility fracture management, identifying areas for its improvement and measuring the impact of clinical initiatives and service change. Hip fracture can be considered a marker for fragility fractures, and hip fracture audits indirectly show strengths and weaknesses of fragility fracture care overall. Notably, where effective hip fracture care exists, this has a favourable impact on the care of other fragility fractures. Early established audits, clinically led, have used clinical standards and feedback on compliance with them to improve care and outcomes. Although data collection, analysis and feedback require investment, the cost per case amounts to only a very small fraction of the cost of care per case. More recently established audits have also proved effective, and increasingly international collaboration on hip fracture audit is now emerging: an important development in view of demographic projections reflecting first-generation mass ageing in a number of large nations. Parallel developments such as fracture liaison services promote both primary and secondary fracture prevention. In future, automated data collection using reliable electronic health records may facilitate audit and international collaboration and enabling instructive comparisons and, eventually, multinational hip fracture-related clinical and epidemiological research.
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