Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture

J Am Geriatr Soc. 2010 Apr;58(4):650-7. doi: 10.1111/j.1532-5415.2010.02769.x.


Objectives: Although osteoporosis treatment can dramatically reduce fracture risk, rates of treatment after hip fracture remain low. In-hospital initiation of recommended medications has improved outcomes in heart disease; hospitalization for hip fracture may represent a similar opportunity for improvement. The objective of this study was to examine rates of in-hospital treatment with a combination of calcium and vitamin D (Cal+D) and antiresorptive or bone-forming medications in patients hospitalized for hip fractures

Design: Observational cohort.

Setting: Three hundred eighteen hospitals in the United States.

Participants: Fifty-one thousand three hundred forty-six patients aged 65 and older hospitalized for osteoporotic hip fracture.

Measurements: In-hospital administration of Cal+D and antiresorptive or bone-forming medications.

Results: Three thousand four hundred five patients (6.6%) received Cal+D anytime after a procedure to correct femoral fracture; 3,763 patients (7.3%) received antiresorptive or bone-forming medications. Only 1,023 patients (2.0%) were prescribed ideal therapy, receiving Cal+D and an antiresorptive or bone-forming medication. Treatment rates remained low across virtually all patient-, provider-, and hospital-level characteristics. The strongest predictor of treatment with Cal+D was the receipt of an antiresorptive or bone-forming medication (adjusted odds ratio=5.50, 95% confidence interval=4.84-6.25), but only 27.2% of patients who received these medications also received Cal+D.

Conclusion: Rates of in-hospital initiation of osteoporosis treatment for patients with hip fracture are low and may represent an opportunity to improve care.

Keywords: Calcium; Hip Fracture; Osteoporosis; Vitamin D.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Density Conservation Agents / therapeutic use
  • Calcium / therapeutic use
  • Drug Therapy, Combination
  • Drug Utilization / statistics & numerical data
  • Female
  • Guideline Adherence / statistics & numerical data
  • Hip Fractures* / epidemiology
  • Hip Fractures* / etiology
  • Hospitalization* / statistics & numerical data
  • Humans
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Osteoporosis / complications
  • Osteoporosis / drug therapy*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • United States / epidemiology
  • Vitamin D / therapeutic use


  • Bone Density Conservation Agents
  • Vitamin D
  • Calcium