Pelvic Fragility Fractures: An Opportunity to Improve the Undertreatment of Osteoporosis

J Bone Joint Surg Am. 2021 Feb 3;103(3):213-218. doi: 10.2106/JBJS.20.00738.


Background: Osteoporosis is often undiagnosed until patients experience fragility fractures. Pelvic fractures are common but underappreciated sentinel fractures. Screening patients with a pelvic fracture for osteoporosis may provide an opportunity to initiate appropriate treatments such as anti-osteoporosis therapy to prevent additional fractures.

Methods: This retrospective cohort review examined the management of osteoporosis after pelvic fractures at a large tertiary care center without an established secondary fracture prevention program. Data were extracted from electronic medical records of all new patients with a pelvic fracture who were ≥50 years of age from this center and its affiliated community hospitals from 2008 to 2014. Outcome measures included the initiation of anti-osteoporosis therapy before the fracture, within the year following the fracture, >1 year following the fracture, or never and new osteoporotic fractures within 2 years after a pelvic fracture.

Results: From 2008 to 2014, 947 patients presented with pelvic fractures. Of these patients, 27.1% (257 patients) were taking anti-osteoporosis medications before the fracture. Four percent of treatment-naïve patients began anti-osteoporosis therapy within 1 year of fracture, with 1.2% (11 patients) starting after 1 year. Of the treatment-naïve patients, 92.3% (637 patients) were never prescribed anti-osteoporosis therapy. Treatment rates were consistent over time. Within 2 years, 41.0% (388 patients) developed fragility fractures at secondary sites: 12.0% (114 patients) experienced a hip fracture, and 16.4% (155 patients) experienced a vertebral fracture.

Conclusions: Osteoporosis screening and initiation of secondary fracture prevention after a pelvic fracture were inadequate in the study population. Of the patients in this study, 909 (96.0%) never underwent a dual x-ray absorptiometry (DXA) scan during the study period. Of the 690 treatment-naïve patients, 637 (92.3%) were never administered anti-osteoporosis medications. Within 2 years, 41.0% of all patients developed additional osteoporotic fractures. This study demonstrates an opportunity to improve bone health by screening for and treating osteoporosis in patients with a pelvic fragility fracture.

Level of evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Absorptiometry, Photon
  • Aged
  • Aged, 80 and over
  • Bone Density Conservation Agents / therapeutic use*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoporosis / diagnostic imaging
  • Osteoporosis / drug therapy*
  • Osteoporotic Fractures / diagnostic imaging
  • Osteoporotic Fractures / prevention & control*
  • Pelvic Bones / diagnostic imaging
  • Pelvic Bones / injuries*
  • Retrospective Studies
  • Secondary Prevention


  • Bone Density Conservation Agents