Osteoporosis treatment following hip fracture: how rates vary by service

Osteoporosis is a prevalent condition among older people. It is often undiagnosed until patients suffer fragility fractures. Previous studies have shown low rates of initiating osteoporosis treatment during the acute hip fracture hospitalization. It is not clear if this varies by the treating service. We compared the rates of instituting osteoporosis treatment during the acute hospitalization for fragility hip fractures.

Rates of initiating treatment among previously untreated patients were compared between the orthopedic, medicine, and rehabilitation services using retrospective cross-sectional chart review at an academic medical center. Between January 2005 and August 2008, 191 patients admitted with a fragility hip fracture survived to be discharged from the hospital.

There were 67 (35%) patients who were started on some form of osteoporosis treatment during their acute hospital stay. Factors statistically associated with starting treatment included having a discharge diagnosis of osteoporosis (P < 0.0001) and treating service (P < 0.0001). Orthopedics was the least likely of the 3 treating services to initiate treatment, while medicine was the most likely.

Overall rates of osteoporosis treatment initiation were low at 35% of the 191 patients' records surveyed. Efforts to increase adherence during the acute hospital stay should be explored. A promising intervention includes instituting an osteoporosis consultative service to improve the likelihood of starting osteoporosis treatment post fragility fracture.