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1144 December 2014 T HE accelerating growth in the world’s elderly population is staggering. The U. S. Census Bureau estimates that the world’s population, over 65 yr of age, grew by 870,000 per month in 2008.* By 2018, the world population is projected to have a net monthly gain of 1.9 million people over 65 yr of age. By 2040, more than one of every four Europeans will be at least 65 yr of age, and one in seven will be at least 75 yr old. In 2040, one in five North Americans will be at least 65. Vaupel and Jeune estimate that over the course of human history, the odds of living from birth to age 100 may have risen from 1 in 20 million to 1 in 50 for low mortality nations such as Japan and Sweden.1 Oeppen and Vaupel2 calculate that, if the past 160-yr trends continue for another 60 yr, people in low mortality countries will live an average of 100 yr! With this increase in the aged population, there is an accompanying increase in prevalence of chronic conditions such as arthritis, cardiac disease, diabetes, hypertension, and obesity. Hip fracture is strongly associated with aging, osteoporosis, and falls. Among the over 99 million adults, 50 yr or older in the United States (in 2010), the prevalence of osteoporosis is estimated at 10.3%.* The lifetime probability of osteoporotic hip fractures, starting at age 50 is 10.7% in Swedish men, and 22.9% in Swedish women.3 In 2010, the annualized rate of nonfatal falls resulting in a visit with a healthcare professional (in the United States) was 43 of 1,000 averaged for all ages and was 115 of 1,000 in those over age 75 yr.4† The 1-yr mortality rate after hip fracture is 20% for elderly females and 26% for elderly males. This excess mortality persists as long as 10 yr after the fracture.5 The 30-day perioperative mortality associated with surgical repair of neck of femur fracture is considerably greater than after primary or revision hip arthroplasty, 10 versus 0.4%, probably due to differences in comorbidity.4,6 In this issue of ANEStHESIOlOgy, Boddaert et al. review this bone health issue and summarize best practices. They focus on the relatively new subspecialty of orthogeriatric medicine, before speculating on the way ahead to improve care.7,8 While we and others may disagree with whether evidence supports some of their recommendations and conclusions (e.g., nerve blocks being done on arrival to the emergency department or the American Society of Anesthesiologists physical status score being “obsolete”), we endorse their approach to this common and vexing problem. Moreover, the “orthogeriatric” concept should no longer be considered innovative: coordinated, multidisciplinary care tailored for hip fracture patients has been described in multiple other publications.9–11‡ The established core management of hip fractures includes protocol-driven, fast-track passage through the emergency department, early surgery, and early mobilization. This is not an elective procedure. Delay of surgery for medical investigations normally should not occur. Preoperative optimization may have value for the occasional patient with correctable cardiac arrhythmias, uncontrolled left-ventricular failure, some reversible coagulopathies, severe anemia, poorly controlled diabetes Improving the Management of Hip Fractures in the Elderly