With a worldwide aging population, the incidence and consequences of geriatric fractures are assuming an increasing importance to health care providers and institutions. Studies have shown that optimal efficient management ensures the best outcome for the patient, at the least cost to the institution. A review of the recent literature was performed to establish the current best evidence ie, gold standard, for geriatric fracture care. Given the complexities of the subject, randomized controlled trials are difficult and confounded by the multiple medical issues of the population being studied. RCT's are best suited to study individual questions, rather than systems of care. Hence, the importance of peer-reviewed models of care, as well as prospective population registries is established in defining what the gold standard of care should be for this vulnerable population.