ORIGINAL ARTICLE After the fall: improving osteoporosis treatment following hip fracture B. W. Kuiper 1 & S. Graybill 2 & J. M. Tate 2 & N. Kaufman 1 & D. Bersabe 3 Received: 7 November 2017 /Accepted: 25 January 2018 # International Osteoporosis Foundation and National Osteoporosis Foundation 2018 Abstract Summary Osteoporotic hip fractures can be life changing and can increase mortality. Treatment of osteoporosis following hip fracture is often delayed. We began offering osteoporosis medication during hospitalization for hip fracture, dramatically in- creasing the number of patients meeting standard of care. Introduction Osteoporotic hip fracture is a debilitating condition with major morbidity and mortality implications. Osteoporosis medication given within 90 days of hip fracture improves mortality and reduces risk of future fractures. The aim of this project was to improve rates of timely osteoporosis treatment following fragility hip fracture. Methods This was a two-step intervention utilizing the Plan-Do-Study-Act cycle, beginning with resident-focused education in cycle 1. In cycle 2, we offered osteoporosis medication to inpatients for hip fracture with help from a new electronic order set. Results Prior to this intervention, 32% of patients received osteoporosis medication within 90 days of fragility hip fracture; this improved to 81% after intervention. Conclusions Resident education and an electronic order set dramatically improved the percentage of patients meeting standard of care with osteoporosis pharmacotherapy following fragility fracture. Keywords Denosumab . Fragility hip fracture . Zoledronate Introduction Osteoporotic hip fractures are an unfortunate but common source of morbidity and mortality for the aging population [1, 2]. Timely medical therapy after hip fracture can mitigate this suffering. Studies show that zoledronate within 90 days of hip fracture reduces all-cause mortality by 28% and provides a 35% risk reduction in new fractures without slowing the sur- gical healing process [3–5]. Despite this clear benefit, rates for osteoporotic pharmacotherapy after fragility fractures are abysmally low [1, 6]. As of 2013, bisphosphonate therapy following fragility hip fracture decreased from 15 to 3% [7]. Only 23% of older women received either a bone mineral density scan or osteoporotic medication within 6 months of fragility fracture [8]. Inpatient teams have tried educating pa- tients about osteoporosis and encouraging outpatient medical management with little success [6]. However, osteoporotic pharmacotherapy during hospitalizations for fragility fracture is gaining popularity [4, 9]. The aim of this project was to provide osteoporosis medication to patients with fragility hip fractures before hospital discharge. We hypothesized that this intervention would improve the rate of patients receiving os- teoporosis medication within 90 days of injury, which is when they can gain the greatest benefit. Methods Upon review of this performance improvement project, Brooke Army Medical Center ’ s Exemption Determination Officer concluded that it did not require an institutional review board (IRB). * B. W. Kuiper brandon.w.kuiper.mil@mail.mil 1 Department of Internal Medicine Residency, SAUSHEC, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, San Antonio, TX, USA 2 Department of Endocrinology, SAUSHEC, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, San Antonio, TX, USA 3 Department of Internal Medicine, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland Air Force Base, San Antonio, TX, USA Osteoporosis International https://doi.org/10.1007/s00198-018-4416-x