Hip fractures are serious, life-limiting and costly events for older adults. Each year in Canada there are over 27,000 hip fractures , and older adults who sustain a low-trauma hip fracture have higher risk of death and disability. In the first year after the fracture, as many as 20% of people die ; and up to half of seniors will not regain their pre-fracture level of mobility [3, 4] leaving them at risk for further falls  and fracture injuries [6–9]. Therefore, despite advances in surgical and medical management following hip fracture, up to half of hip fracture patients do not regain their independence or return to prefracture functional mobility.
After hip fracture, systematic structured follow-up strategies for older adults [10, 11] improve investigation rates for osteoporosis; and fracture liaison services [10–23] after fracture are beneficial. Many previous interventions, however, have focused on bone health management, and to our knowledge only a few studies [18, 20] have included patient referral for falls risk assessment. Osteoporosis care can be improved, but as fractures occur because of low bone mass and falls, it is important to also address falls risk . It is noteworthy that despite being prescribed osteoporosis medication  some patients who attended a fracture liaison service had a subsequent fall-related low trauma fracture. Hence, the need to coordinate both falls prevention and bone health initiatives .
Ferrucci and colleagues  discuss that hip fracture can result in "catastrophic disability" for older adults due to the unanticipated deterioration in functional ability  in some activities of daily living and mobility. Decreased mobility, in turn, impacts on the risk for future injury. Importantly, older adults who sustain hip fracture are at an increased risk of future hip fracture [26, 27]. A systematic review  emphasized that previous falls , low bone density [28, 29], and mobility impairment  are major risk factors for second hip fracture. Approximately 90% of fractures occur as a result of a fall  and after hip fracture, up to half of people can fall again within the first 6 months following fracture [5, 31]. These data emphasise the importance of a two-pronged approach to reducing hip fractures - addressing falls risk as well as low bone mass .
Compelling evidence supports the recommendation for strength and balance exercises for falls risk reduction in vulnerable populations [33–36]. Exercise improves lower limb muscle strength and it can maintain bone mass in post-menopausal women [37–39]. A Cochrane systematic review  reported six trials that evaluated exercise interventions for people after hospital discharge following hip fracture. Balance and strength measures improved overall; in particular, Binder and colleagues  reported a significant improvement in mobility measures after a six month out-patient physical therapy intervention.
Therefore, the purpose of the current study is to evaluate the clinical and cost effectiveness of a novel post-discharge fracture management strategy for community-dwelling older adults after hip fracture. It is anticipated that initiating an individualized outpatient management program after hospital discharge, which includes falls and fracture risk assessment and management, and an individualized exercise program under the ongoing guidance of a physical therapist, will improve mobility, and reduce disability and falls.