ABSTRACT Objective: To determine whether patients with fragili- ty hip fractures underwent assessment and treatment of osteoporosis during initial hospitalization or recommenda- tions for such intervention were made to the primary care provider (PCP) at the time of hospital dismissal. Methods: A review of medical records of patients admitted with a low-impact hip fracture to the Royal University Hospital in Saskatoon, Saskatchewan, Canada, was performed to determine whether recommendations were made to evaluate for or treat osteoporosis. In addi- tion, a questionnaire was sent to the orthopedic surgeons practicing at the hospital to help identify barriers to wide- spread diagnosis and treatment of osteoporosis in such patients. Results: Between January and December 2004, 174 patients with fragility hip fractures were admitted to the Royal University Hospital. The mean age of these patients was 82.5 ± 9.8 years. Evaluation for treatment of osteo- porosis was recommended in only 9 patients (5%). We found no significant differences in the intervention rates between male and female patients, between patients with and those without a prior history of osteoporosis or frac- ture, between patients who were previously taking osteo- porosis medications and those who were not, and between patients who were seen by a medical consultant and those who were not. Most orthopedic surgeons believed that they were primarily responsible for the surgical care of these patients, and because they did not see these patients in regular follow-up, the management of osteoporosis was considered the responsibility of the PCP. Conclusion: The results of this study indicate that only a small number of patients with fragility hip fractures receive appropriate evaluation or treatment for underlying osteoporosis either during initial hospitalization or at the time of dismissal from the hospital. In this study, most orthopedic surgeons believed that evaluation and treat- ment of osteoporosis were the responsibility of the PCP. Because these patients have an increased risk for future fractures, barriers to the diagnosis and treatment of osteo- porosis need to be removed, and health-care professionals need to be educated about appropriate risk factor modifi- cation in these patients. (Endocr Pract. 2005;11:370- 375) INTRODUCTION Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and consequent increase in fracture risk (1). Sustaining a fragility fracture is a seminal event in patients with osteoporosis. A fragili- ty fracture, defined as a fracture occurring with minimal trauma no greater than the trauma that would be experi- enced with a fall on a level surface while walking or stand- ing, increases the risk of future fractures. A distal radial fracture doubles the risk of a future hip fracture (2). A ver- tebral fracture, even a subclinical vertebral fracture, increases the risk of occurrence of another vertebral frac- ture by fourfold to fivefold, and as many as 20% of patients with vertebral fractures who are not treated for osteoporosis will have a second vertebral fracture within a year (3). A vertebral fracture also doubles the risk of sus- taining a hip fracture, and a previous hip fracture increas- es the risk of a second hip fracture by as much as sixfold (4-7). Most patients with fragility fractures will have bone mineral density (BMD) measurements that demonstrate osteopenia or osteoporosis. In general, each 1 SD decrease in BMD approximately doubles the risk of having a frac- ture (8). Several agents, both nonpharmacologic and phar- macologic, effectively treat osteoporosis and reduce the EVALUATION AND TREATMENT OF OSTEOPOROSIS IN PATIENTS WITH A FRAGILITY HIP FRACTURE Hasnain M. Khandwala, MD, FRCPC, 1 Nathan Kolla, BA, BSc, MA, MD, 1 and Vaneeta K. Grover, MA, MSc 2 Submitted for publication May 26, 2005 Accepted for publication July 14, 2005 From the 1 Department of Medicine, Division of Endocrinology, and 2 Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Address correspondence and reprint requests to Dr. Hasnain M. Khandwala, Royal University Hospital, Division of Endocrinology, Room 3654, 103 Hospital Drive, Saskatoon, SK, Canada S7N 4R3. © 2005 AACE. 370 ENDOCRINE PRACTICE Vol 11 No. 6 November/December 2005 Original Article Abbreviations: BMD = bone mineral density; PCP = primary care provider