Proximal femur fractures (hip fractures) have serious impact on older people, as morbidity and mortality rates are above 30% in the first year after the fracture [1,2,3,4]. A mere half of the patients have regained their pre-accident functional status a year after surgery and one in every four patients who were ADL-independent before their hip fracture ends up in a nursing home [1, 2, 5].

The risk of complications related to the hip surgery is affected by pre-accident functional status as well as by age, sex, body mass index, length of hospital stay, and the time elapsed between the accident and surgery [1, 4, 6]. Early active walking and physical exercise reduce the complication rate as well as the need for prolonged inpatient treatment [4].

Geriatric co-management of older hip fracture patients has been shown to lead to shorter hospital stay, fewer complications, reduced readmission rates, lower costs, better health-related quality of life, and lower mortality. [1, 4, 5] Also, with geriatric co-management of older hip fracture patients the hospital discharge location is more often a rehabilitation center rather than a nursing home [5].

Based on these results, the Dutch guideline for the management of hip fractures in older patients recommends to involve a geriatrician in the management of every admitted older (i.e. ≥ 70 years) hip fracture patient and this is common practice in most hospitals in the Netherlands [7, 8]. However, the growing older population, their increasing pressure on the healthcare system and the shortage of healthcare professionals call for a more efficient approach [9]. Limiting geriatric co-management to older hip fracture patients that are likely to benefit most from it would make their in-hospital management more (cost-)efficient and sustainable for the future.

Clearly the criteria for such a selection process should be based on evidence-based prognostic factors and easy to implement in clinical practice. One potential prognostic factor that—at least to our knowledge—has not been investigated yet is whether or not the hip fracture was caused by a bicycle accident. Previous research has shown that outdoor falls have a lower complication rate compared to indoor falls, the former also being associated with younger age and better health status at the time of injury [3, 10]. As cycling is associated with a good health status [11] and, consequently, riding a bike may be an easy to identify proxy of good health, this may be a useful and easy to apply criterion when selecting older hip fracture patients for omitting geriatric co-management.

In this study we hypothesized that older (≥ 70 years) patients who are admitted to our hospital with a hip fracture due to a bicycle accident have a more favorable prognosis in terms of length of hospital stay, risk of complications during hospitalization and discharge destination compared to older subjects whose hip fracture was caused by another type of accident.