Factors influencing the treatment of osteoporosis following fragility fracture

Osteoporos Int. 2009 Nov;20(11):1911-9. doi: 10.1007/s00198-009-0898-x. Epub 2009 Mar 31.


Treatment rates of osteoporosis after fracture are very low. Women who suffer a fragility fracture have a greater chance of receiving anti-fracture treatment if they had low bone mineral density (BMD), a fracture at the hip, femur or pelvis, administration of calcium and vitamin D supplements and/or an age > or =60 years.

Introduction: This investigation identifies the predictors of osteoporosis treatment 6 to 8 months following fragility fracture in women >50 years of age.

Methods: In this prospective cohort study, women were recruited 0 to 16 weeks following fracture and classified as having experienced fragility or traumatic fractures (phase 1). Six to 8 months following fracture, women completed a questionnaire on demographic features, clinical characteristics and risk factors for osteoporosis (phase 2). Osteoporosis treatment was defined as initiating anti-fracture therapy (bisphosphonate, raloxifene, nasal calcitonin and teriparatide) after fracture in those previously untreated.

Results: Of the 1,273 women completing phase 1, 1,001 (79%) sustained a fragility fracture, and of these women, 738 were untreated for osteoporosis at phase 1 and completed the phase 2 questionnaire. Significant predictors of treatment included BMD result, fracture site, administration of calcium and vitamin D supplements at the time of fracture and age > or =60 years. All other risk factors for osteoporosis, such as fracture history after the age of 40 years, family history of osteoporosis and comorbidities did not significantly influence the treatment rate.

Conclusions: Physicians largely based their decision to treat on BMD results and not on the clinical event-fragility fracture.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bone Density
  • Bone Density Conservation Agents / therapeutic use*
  • Calcium / therapeutic use
  • Decision Making
  • Dietary Supplements
  • Drug Utilization / statistics & numerical data
  • Female
  • Humans
  • Middle Aged
  • Osteoporosis, Postmenopausal / complications*
  • Osteoporosis, Postmenopausal / drug therapy*
  • Osteoporosis, Postmenopausal / physiopathology
  • Osteoporotic Fractures / etiology*
  • Osteoporotic Fractures / pathology
  • Osteoporotic Fractures / prevention & control
  • Patient Selection
  • Secondary Prevention
  • Socioeconomic Factors
  • Vitamin D / therapeutic use


  • Bone Density Conservation Agents
  • Vitamin D
  • Calcium