The average age at hip fracture is 83 for women and 84 for men, with around 80% of cases in women. The reported 30% mortality and 20% new institutionalisation rates at 12 months reflect the high prevalence of comorbidity and to some extent suboptimal management at the time of the fracture. With timely intervention and better clinical management many fractures can be prevented and even when they do occur their human and economic costs can be greatly reduced.  Prevention and management span a full spectrum of typical need from primary prevention through acute an rehabilitative management to secondary prevention and long-term and palliative care. Changing what happens in acute hospitals is fundamental to this challenge, but the achievement of seamless clinical continuity across primary, secondary and social care is equally important.