B4 and after: An investigation into hip fracture recovery

6 December 2013

This blog post describes the B4 Clinic, a novel specialized fracture follow-up clinic that aims to address gaps in care and help older adults maintain mobility.

Megan McAllister is the research coordinator for the B4 Study, which runs through the Activity & Aging Lab (A3) at the Centre for Hip Health & Mobility (CHHM). Dr. Maureen Ashe is Associate Professor in the UBC Department of Family Practice, an investigator at the CHHM, a MSFHR Scholar and a CIHR New Investigator. Read about the A3 Lab.

More blog posts: Spark >> A BC Health Research Blog

Maggie is an eighty-year-old grandmother who was actively involved in her community. Every morning she would wake up, go for her walk, and meet a friend for coffee.

One morning, while out on her daily routine she slipped on some wet leaves and fell onto her hip – the pain was blinding. She knew instantly that there was something wrong. What she did not know was the extent to which her life was about to change.

Hip fractures are serious. Within the first year, as many as one in five older adults with hip fracture will die,[1] and half will not regain their pre-fracture mobility,[2, 3] setting them at an increased risk of future falls and injuries.[4]

Thus, the recovery pathway for Maggie may take time with some complications along the way. Further, after this low-trauma fracture it is important that Maggie is assessed for her bone health to determine the reason she fell in the first place.

Many studies have investigated care around the time of fracture, and a few have looked into care following discharge from hospital.[5] Addressing care gaps in the investigation and treatment of osteoporosis following low trauma, or fragility fracture, is an important issue. In addition, as fractures occur due to low bone mass and falls, it is import to treat both risk factors,[6] yet to our knowledge there are few existing programs.[7-9]

Our lab seeks to address this care-gap with a novel specialized fracture follow-up clinic – the B4 Clinic. The B4 Clinic addresses four key domains to maintain mobility with the aim of preventing future falls (and hopefully fractures). The four target areas for assessment include Bone Health, Brain Function, Bladder Function and Balance.

As part of the study, participants receive a comprehensive geriatric evaluation based on current evidence [10] and physiotherapy assessment. If warranted, they are referred to an outpatient physiotherapy program and/or other relevant health care professionals (occupational therapists, nursing) or medical specialists.

As a one-stop-shop, we hope the B4 Clinic will decrease fracture risk factors; although our specific aim in this study is to increase participants’ mobility to pre-fracture levels so people like Maggie can get back to enjoying their previous lifestyle.

We are currently testing the effectiveness and cost-effectiveness of the B4 Clinic through a randomized control trial. Should the B4 Clinic prove effective, we hope to evaluate implementation and scale up of the B4 Clinic within the standard post-hip fracture care pathway.

For more information on the B4 Study please visit ClinicalTrials.gov: NCT01254942 or BMC Geriatrics for the full protocol doi:10.1186/1471-2318-11-30



  1. Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 2003; 51(3): 364-70.
  2. Eastwood EA, Magaziner J, Wang J, et al. Patients with hip fracture: subgroups and their outcomes. J Am Geriatr Soc 2002; 50(7): 1240-9.
  3. Penrod JD, Litke A, Hawkes WG, et al. Heterogeneity in hip fracture patients: age, functional status, and comorbidity. J Am Geriatr Soc 2007; 55(3): 407-13.
  4. Berry SD, Samelson EJ, Hannan MT, et al. Second hip fracture in older men and women: the Framingham Study. Arch Intern Med 2007; 167(18): 1971-6.
  5. Beaupre LA, Allyson Jones C, Duncan Saunders L, Johnston DWC, Buckingham J, Majumdar SR. Best practices for elderly hip fracture patients. Journal of general internal medicine 2005; 20(11): 1019-25.
  6. Langridge CR, McQuillian C, Watson WS, Walker B, Mitchell L, Gallacher SJ. Refracture following fracture liaison service assessment illustrates the requirement for integrated falls and fracture services. Calcif Tissue Int 2007; 81(2): 85-91.
  7. van Helden S, Cals J, Kessels F, Brink P, Dinant GJ, Geusens P. Risk of new clinical fractures within 2 years following a fracture. Osteoporos Int 2006; 17(3): 348-54.
  8. Wright SA, McNally C, Beringer T, Marsh D, Finch MB. Osteoporosis fracture liaison experience: the Belfast experience. Rheumatol Int 2005; 25(6): 489-90.
  9. Majumdar SR, Lier DA, Beaupre LA, et al. Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch Intern Med 2009; 169(1): 25-31.
  10. American Geriatrics Society British Geriatrics Society. AGS/BGS clinical practice guideline: prevention of falls in older persons. New York, NY: American Geriatrics Society; 2010.

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