International benchmarking of secondary fracture prevention in older adults with hip fracture: a Chinese hospital-based KPI audit.

OBJECTIVE

This study provides the first international benchmarking of postoperative hip fracture care in Chinese tertiary hospitals using the UK Fracture Liaison Service (FLS) Key Performance Indicators within a "cascade of care" framework.

METHODS

This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. We conducted a retrospective audit of 2,689 patients aged ≥60 years who received hip fracture surgery in an orthogeriatric co-managed ward from 2016 to 2018. Performance was measured against seven validated FLS KPIs: bone mineral density (BMD) screening, anti-osteoporosis medication initiation, falls risk assessment, rehabilitation provision, follow-up adherence, and secondary fracture incidence at specified time points.

RESULTS

Inpatient metrics were excellent: 97.1% (2,610/2,689) underwent BMD screening and 94.0% (2,454/2,610) received bone-protective medication prior to discharge, both exceeding UK benchmarks. Post-discharge follow-up declined sharply: 50.7% (1,363/2,689) at 90 days, 17.7% (477/2,689) at 12-16 weeks, and 9.5% (255/2,689) at 12 months. Secondary fracture rates remained high (11.0-13.4%) across follow-up intervals despite strong treatment initiation. International comparison highlighted strengths in acute inpatient management but exposed deficits in community-based coordination and long-term adherence relative to integrated FLS models.

CONCLUSION

This pioneering international comparison demonstrates that Chinese hospital-centric orthogeriatric co-management delivers outstanding acute care but struggles with sustained secondary fracture prevention due to fragmented healthcare pathways and limited primary care integration. Implementation of dedicated FLS coordinators, digital engagement tools, and structured hospital-community partnerships is essential to build a comprehensive secondary prevention network and reduce long-term fracture risk in China's aging population.