Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis

Osteoporos Int. 2019 Jul;30(7):1371-1381. doi: 10.1007/s00198-019-04944-5. Epub 2019 Apr 2.


We investigated the timeline of functional recovery after hip fracture over 12 months in adults age ≥ 65 years using objective lower extremity function tests and subjective physical functioning. Objective functional recovery was largely complete in the first 6 months, whereas subjective recovery improved up to 9 months after hip fracture.

Introduction: Hip fractures are a major cause of loss of function among seniors. We assessed the timeline of objective and subjective functional recovery after hip fracture.

Methods: We conducted a prospective observational secondary analysis of a 1-year clinical trial on vitamin D and home exercise treatment and complications after hip fracture among 173 patients age ≥ 65 years (mean age 84 years; 79.2% women; 77.4% community-dwelling) conducted from January 2005 through December 2007. Lower extremity function (Timed Up and Go test (TUG), knee extensor and flexor strength) and grip strength was assessed at baseline and at 6 and 12 months follow-up. Subjective physical functioning was assessed using the SF-36 questionnaire also at 3 and 9 months follow-up. Multivariable-adjusted repeated-measures models were used to assess the timeline of functional recovery in the total population and in subgroups of patients.

Results: Lower extremity function including TUG (- 61.1%), knee extensor (+ 17.6%), and knee flexor (+ 11.6%) strength improved significantly in the first 6 months (P < 0.001). However, between 6 and 12 months, there was no further significant improvement for any of the functional tests. Grip strength decreased from baseline to 6 months (- 7.9%; P < 0.001) and from 6 to 12 months (- 10.8%; P < 0.001). Subjective physical functioning improved from 3 to 9 months (+ 15.2%, P < 0.001), but no longer thereafter.

Conclusions: Functional recovery after hip fracture may be largely complete in the first 6 months for objective functional tests, whereas may extend up to 9 months for subjective recovery, with oldest-old, female, institutionalized, and cognitively impaired patients recovering most poorly.

Clinical trials registry (original trial): NCT00133640.

Keywords: Functional recovery; Hip fracture; Objective functional tests; Subjective physical functioning; Timeline.

Publication types

  • Observational Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Density Conservation Agents / therapeutic use
  • Cholecalciferol / therapeutic use
  • Exercise Therapy
  • Female
  • Follow-Up Studies
  • Hand Strength / physiology
  • Hip Fractures / physiopathology
  • Hip Fractures / rehabilitation*
  • Hip Fractures / surgery
  • Humans
  • Knee Joint / physiopathology
  • Lower Extremity / physiopathology
  • Male
  • Postoperative Period
  • Prospective Studies
  • Recovery of Function / physiology*
  • Residence Characteristics
  • Self Report


  • Bone Density Conservation Agents
  • Cholecalciferol

Associated data

  • ClinicalTrials.gov/NCT00133640