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FR A C TU RE vertebral, and distal radius fractures. The quality of life that follows such a fracture, particularly a hip fracture, is a major public-health concern5,7. Osteoporotic hip fractures are associated with substantial morbidity, loss of function, and a one-year mortality rate of as high as 33%8 . In 1995, health-care expenditures attributable to osteoporotic fractures were estimated to be $13.8 billion9 . It has been shown that a personal history of an osteoporotic hip fracture is a major risk factor for a future fragility fracture10-16 and that a second, contralateral hip fracture may occur in as many as 10.6% of patients17 . Because elderly patients who have a hip fracture are often hospitalized for definitive orthopaedic management, they present an excellent, albeit late, opportunity for antiosteoporotic treatment. General guidelines have been elucidated by the National Osteoporosis Foundation18 but must be tailored to this particular group of hospitalized patients following an osteoporotic fracture. Minimally, patients should be advised on the importance of dietary or supplemental calcium and vitamin-D sources, such as multivitamins. In addition, however, many patients who have sustained an osteoporotic fracture will have severe osteoporosis and will warrant treatment with an antiresorptive agent. Estrogen, calcitonin, bisphosphonates, and raloxifene have been studied extensively recently, and all are options for medical treatment. Specific therapy decisions are patient-specific and beyond the scope of this paper. Freedman et al.19 demonstrated that patients with osteoporotic fractures are inadequately treated for osteoporosis in the outpatient setting. Recognizing this deficiency, the National Osteoporosis Foundation and the American Academy of Orthopaedic Surgeons have established guiding principles for the treatment of patients with osteoporotic fractures. The purpose of the present study was twofold. First, we wished to retrospectively assess the rate at which physicians recognized and treated osteoporosis in patients who were admitted to the hospital with typical low-energy osteoporotic hip fractures over a recent four-year period in order to test the hypothesis that osteoporosis treatment was lacking in the majority of cases. Second, we wished to determine if the physician education efforts spearheaded by the National Osteoporosis Foundation and sponsored secondarily by the American Academy of Orthopaedic Surgeons have led to a significant improvement in treatment. Materials and Methods atients who were included in the orthopaedic trauma service databases at three different hospitals (two university medical centers and one university-affiliated community hospital) were sorted by ICD-9 (International Classification of Diseases, Ninth Revision) codes for femoral neck fractures. The first twenty-five patients with an age of more than fiftyfive years who were admitted during the calendar year because of a femoral neck fracture and who qualified were included in the study. Patients with a high-energy mechanism of injury (other than a fall at ground level), patients who were less than fifty-five years old, and premenopausal women were disqualified. Twenty-five patients from each center for each year between 1997 and 2000 were included. The medical records and charts were then analyzed with regard to the admitting diagnosis, mechanism of injury, admission medications, procedures performed during hospitalization, and discharge medications. In the group treated in 1997, the average age was 78.7 years and fifty-five (73%) of the seventy-five patients were female. In the group treated in 1998, the average age was 80.6 years and fifty-three patients (71%) were female. In the group treated in 1999, the average age was 79.7 years and fifty-seven patients (76%) were female. In the group treated in 2000, the average age was 78.9 years and fifty-five patients (73%) were female. The average age of all 300 patients in the study was 79.5 years, and 220 (73%) of the 300 patients were female. The variables that were examined included the number of patients with a low-energy osteoporotic fracture who were taking antiresorptive medications at the time of discharge and P TABLE I Data on the Treatment of Osteoporosis Following Low-Energy Hip Fracture* Year No. of Patients Average Age (yr) Osteoporosis Treatment During Hospitalization†Percentage of Patients Being Treated for Osteoporosis at Discharge No Change in Treatment Change in Treatment New Treatment Total 1997 which of these patients reported having taken such medications prior to admission. There were four possible scenarios: (1) the patient was taking such medication prior to admission and no change was made at the time of discharge, (2) the patient was taking such medication prior to admission and a change was made at the time of discharge, presumably in response to the fracture, (3) the patient was taking no such medication prior to admission and a new medication was prescribed at the time of discharge, and (4) the patient was discharged without having received any treatment for osteoporosis. In addition, each of these four outcomes was analyzed with regard to whether the medication was supplemental calcium or a prescription antiresorptive medication, such as calcitonin, estrogen, a bisphosphonate, or
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