ORIGINAL ARTICLE Factors influencing the treatment of osteoporosis following fragility fracture L. Bessette & S. Jean & K. S. Davison & S. Roy & L.-G. Ste-Marie & J. P. Brown Received: 17 November 2008 / Accepted: 3 February 2009 / Published online: 31 March 2009 # International Osteoporosis Foundation and National Osteoporosis Foundation 2009 Abstract Summary Treatment rates of osteoporosis after fracture are very low. Women who suffer a fragility fracture have a greater chance of receiving anti-fracture treatment if they had low bone mineral density (BMD), a fracture at the hip, femur or pelvis, administration of calcium and vitamin D supplements and/or an age ≥60 years. Introduction This investigation identifies the predictors of osteoporosis treatment 6 to 8 months following fragility frac- ture in women >50 years of age. Methods In this prospective cohort study, women were re- cruited 0 to 16 weeks following fracture and classified as having experienced fragility or traumatic fractures (phase 1). Six to 8 months following fracture, women completed a questionnaire on demographic features, clinical character- istics and risk factors for osteoporosis (phase 2). Osteopo- rosis treatment was defined as initiating anti-fracture therapy (bisphosphonate, raloxifene, nasal calcitonin and teripara- tide) after fracture in those previously untreated. Results Of the 1,273 women completing phase 1, 1,001 (79%) sustained a fragility fracture, and of these women, 738 were untreated for osteoporosis at phase 1 and completed the phase 2 questionnaire. Significant predictors of treatment included BMD result, fracture site, administration of calcium and vitamin D supplements at the time of fracture and age ≥60 years. All other risk factors for osteoporosis, such as fracture history after the age of 40 years, family history of osteoporosis and comorbidities did not significantly influ- ence the treatment rate. Conclusions Physicians largely based their decision to treat on BMD results and not on the clinical event—fragility fracture. Keywords Care gap . Determinants . Fragility fracture . Osteoporosis . Treatment predictors Introduction The occurrence of fragility fracture is a major public health concern due to associated increased premature mortality, morbidity, and financial burden [1–4]. A prior fragility fracture represents a significant risk for subsequent fracture, independent of bone mineral density (BMD) [5–11]. Despite the comparatively simple diagnostic criteria for osteoporosis and the availability of a number of effective anti-fracture treatments [12–18], osteoporosis is under- investigated and under-treated [19–24], even in high-risk groups of individuals who have suffered a previous fragility fracture [19]. Even though the care gap in the management of the disease has been widely recognised, few studies have investigated the determinants of treatment following fragil- ity fracture. The Recognizing Osteoporosis and its Consequences in Quebec (ROCQ) programme is a prospective cohort study and disease health management programme aimed at evaluating the diagnostic and treatment care gap following Osteoporos Int (2009) 20:1911–1919 DOI 10.1007/s00198-009-0898-x L. Bessette (*) : K. S. Davison : J. P. Brown Department of Medicine, CHUL Research Centre, Laval University, 2705, Laurier Boulevard, Room S-784, Quebec City, PQ, Canada, GIV 4G2 e-mail: louis.bessette@crchul.ulaval.ca S. Jean : S. Roy Institut National de Santé Publique du Québec, Sainte-Foy, PQ, Canada L.-G. Ste-Marie Department of Medicine, Centre de Recherche du CHUM, Hôpital Saint-Luc, University of Montreal, Montréal, PQ, Canada