Falls are the leading cause of death for the over-75s
Opportunities to prevent recurrent falls and fractures in the elderly are being missed, experts have warned.
Every year, more than 700,000 people over 65 in the attend A&E after a fall.
But the Healthcare Quality Improvement Partnership says many hospitals in England, Wales and Northern Ireland are not adhering to best practice.
The audit found serious gaps in aftercare services for those who had had a fall. The government said it was taking action to improve services.
The researchers from the Royal College of Physicians found little improvement had been made since their first audit in 2005.
Results came from 93% (315/337) of acute trusts, primary care organisations (PCOs) and health and social care trusts in England, Wales and Northern Ireland.
Only half of providers with an A&E or minor injury unit routinely screen older people attending with falls for risk of future falls.
And less than half (44%) check whether elderly patients admitted with a fracture has brittle bones because of osteoporosis, despite good evidence showing half of hip fracture patients have had a previous fragility fracture.
Do the right thing
Half of providers do not carry out eye checks to see if this could have been the cause of the fall. Similarly, half of the PCOs do not check for heart conditions, which can cause fainting.
Home checks for hazards that make falls more likely, such as loose carpet, are also recommended.
But only 41% of the providers follow a validated approach to this.
"Major variation between trusts persist, and deficiencies in care remain widespread," the report concluded.
Falls are the leading cause of death for the over-75s.
Hip fractures, which occur in about 60,000 people a year who fall, cost the NHS £1.7bn and are associated with up to 14,000 deaths.
But well organised services can prevent future falls and reduce death and disability from fractures.
Robin Burgess, chief executive of HQIP, said: "This audit really highlights the need to address the shortfalls in aftercare services being offered to patients who have fallen and fractured bones."
Nick Rijke of the National Osteoporosis Society said: "The incredible numbers of people suffering fragility fractures is not a mere statistic.
"Fractures have a profound impact on quality of life, greatly diminishing mobility and independence.
"By correctly identifying those at risk, NHS trusts could save time, money and most importantly, lives."
David Stout, director of the Primary Care Trust Network, said: "It is important that all primary care trusts have the necessary services for falls and bone health in place, including the provision of services for secondary prevention of fractures.
He said some were progressing well, but there were others that could improve.
"It is important to remember that PCTs must balance competing priorities for a wide range of services," he added.
A Department of Health spokeswoman said there were several regional pilot projects already in place which were contributing to best practice in prevention and they were developing a series of tools for the NHS to use to improve care and spread good practice.