Two hundred and twenty patients with geriatric hip fractures were randomized to receive either preoperative IV ferric carboxymaltose 1000 mg ~12 h before surgery (n=110) or no iron (n=110), with all patients managed using a restrictive transfusion threshold (primarily Hb <8 g/dL or symptomatic). The primary outcome was all-cause mortality at 6 and 12 months. Secondary outcomes included perioperative transfusion, hemoglobin (preop, 24 h postop, discharge, 6 weeks), length of stay, and safety signals (including hypophosphatemia). Overall, the results of the study revealed lower 6-month (22.9% vs 39.0%; p=0.011) and 12-month mortality (28.4% vs 42.9%; p=0.028) and fewer transfused patients (30% vs 46%; p=0.013) with FCM. Multivariable models identified preoperative FCM as independently protective at both timepoints. In short, preoperative high-dose IV iron reduced mortality and transfusion exposure in this high-risk population.