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Of these 115 patients, 92 patients (80%) were prescribed osteoporosis medications (73 patients [79.3%] in bisphosphonates, 16 patients in SERM, and 3 in PTH) at time of discharge and first visit of out-patients clinic after discharge. Other anti-osteoporotic drugs, such as, calcitonin, and hormone replacement therapy were not prescribed. At six months follow-up, 83 patients (72.2%) were maintained osteoporosis medications (67 patients in bisphosphonates, 13 patients in SERM, and 3 in PTH). Six patients were stopped medication due to gastrointestinal-related complication and 3 patients were loss of follow-up. At 12 months followup, 74 patients (64.3%) were maintained osteoporosis medications (63 patients in bisphosphonates and 11 patients in SERM). Two patients were refused osteoporosis medications due to difficulty of medication and/or complications. Six patients were died during follow-up. One patient was lost of follow-up at 12 months follow-up. DISCUSSION Undertreatments of osteoporosis in patients with hip fracture are notorious and considering problems to overcome. We found that improvement of patient’s awareness through education could lead to increase rate of detection and treatment of osteoporosis after hip fracture. Comparing with previous reports (36.4% of BMD testing and 23.1% of osteoporosis medication) in the same cohort,[13] education of patients with hip fracture are increasing 60.5% of BMD testing, and 48.4% of osteoporosis medication at discharge and 40.2% of osteoporosis medication at the 12 months follow-up. Several interventional studies for improving osteoporosis management following hip fracture have demonstrated that patients and/or physicians education can lead to improvement of initiation rate of anti-osteoporosis medications in patients with hip fracture.[14-19] Previously, we performed interventional study for improving orthopaedic surgeon awareness and reported an improved medication rate of osteoporosis from 15% to 32% in patients with hip fracture.[12] However, 32% of the osteoporosis treatment rate at six months following hip fracture was still lower than other intervention studies.[12] Therefore, we designed multimodal interventional study for patients and orthopaedic surgeons and resulted in improvement of osteoporosis medication from 23.1% to 40.2% at 12 months follow-up. In terms of medication persistence in interventional study, for preventive effect of osteoporotic fracture, anti-osteoporosis medication should be taken for minimum 6 months. [20] However, medication duration times in several studies are relatively short within 6 months.[20] Increasing rate of osteoporosis medication in patient with hip fracture use beyond 6 months of the intervention ranged from 16% to Table 1. Patient’s demographic data Number of patients (hips) 222 Exclude of patients 32 High-energy injury 9 Non-residents 3 Mental illness 3 Chronic renal failure 5 Previous cancer history 3 Bedridden status 5 Refused informed consents 4 Participant patients 190 Hospitals (six hospitals, hips) Our findings are corresponded with other previous reports. In this study, comparing with control group, increasing rate of anti-osteoporosis medication was increased by 17.2% and medication persistence was 40.2% at the 12 months follow-up. Especially, intervention study for patients with hip fracture is important advantage, because patients after surgical intervention should be recommended regularly scheduled visits for radiological and clinical evaluations. So far, intervention studies have involved one or two specific centers, and it is difficult to extrapolate their results at other university and local hospitals. The results of this multicenter study could be shown possibility to expendable an effective and easily applied intervention method in osteoporotic patients with a hip fracture. The fracture liaison services for hip fracture patients have been introducing since last decade. Fracture liaison services are proven as an effective method to address the post-fracture care gap, cost effectiveness, and to reduce the risk of secondary fracture.[11,21- 23] Program of fracture liaison service are mainly consisted with patient’s education including knowledge of osteoporosis, importance of anti-osteoporosis medications, calcium and vitamin D rich food intake, and physical exercise.[24] Education programs in this study were very similar to program of fracture liaison service. Therefore, success of this prospective multicenter interventional study was shown possibility of conversion to fracture liaison service in Korea. This study has some limitations. First, this study was performed in various hospital settings within the same cohort, although education programs were standardized in all institutions. Second, the medical care system in Korea is not a same to other countries, because orthopedic surgeons undertake the role of primary care physicians after surgery. Therefore, the results of intervention programs in this study might be difficult to generalize in the other countries. However, recent studies have shown that the active participation of orthopedic surgeons is possible to improve osteoporosis treatment in patients with hip fracture. Finally, comparing control study, two hospitals had to exclude because of IRB permission. This change might have influenced on the
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