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

Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture.

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  • 1San Francisco VA Medical Center, and Department of Medicine, University of California San Francisco, San Francisco, California, USA. lee.jennings@ucsf.edu



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


Observational cohort.


Three hundred eighteen hospitals in the United States.


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


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


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.


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


Calcium; Hip Fracture; Osteoporosis; Vitamin D

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