Purpose: Recognizing Osteoporosis and Its Consequences in Québec revealed that 73% of women 50y and over are not provided anti-fracture therapy following fragility fracture. This study’s objectives were to determine predictors of osteoporosis (OP) diagnosis (DX) and treatment (TX) 6 to 8 months after fragility fracture.

Method: At phase 1, women were recruited at cast or out-patient clinics within 16 weeks post-fracture. Consenting patients answered a short questionnaire classifying them as experiencing a fragility or traumatic fracture; no reference to the association between fracture and OP was made and no investigation or intervention was proposed. At phase 2, 6–8 months post-fracture, the women completed a questionnaire on demographic features, clinical characteristics and risk factors for OP. The DX (informed of OP and/or BMD measurement with diagnosis of OP) and TX (bisphosphonates, raloxifene, nasal calcitonin or teriparatide) rates of OP were determined via this questionnaire. This analysis included only women with a fragility fracture who were not receiving OP TX at phase 1.

Results: Of the 1273 women completing phase 1, 1001 (79%) sustained a fragility fracture; 818 were untreated at phase 1 and completed the phase 2 questionnaire. Overall, 79% of these participants had not received a DX of osteoporosis or were without OP TX at phase 2. The highest rate of DX and TX of OP occurred 0–5 months post-fracture and decreased considerably thereafter. In multivariate analyses, the results of BMD tests before or after the fracture event (p< 0.0001) and mobility problems (p=0.03) were the only variables that influenced the DX of OP. BMD test results were the strongest predictor (p< 0.0001) of TX followed by the fracture site (hip, femur and pelvis; p=0.015) and administration of vitamin D supplements at the time of fracture (p=0.035). No other risk factors for OP significantly influenced the DX or TX rate. No demographic or clinical features or OP risk factors were significantly associated with the decision to refer women for BMD testing post-fracture.

Conclusion: Although fragility fracture represents a greater risk of future fragility fracture than low BMD, physicians based their decision to treat on BMD and not the clinical event (fragility fracture).

A descriptive study of osteoporotic fractures and the evaluation of the relative risk of hip fracture following a minor fracture were done on 2.5 million individuals from 1980 to 1997. People aged forty-five years old and older have a risk for hip fracture after a minor fracture of 2.3–17.3 time the risk of people without previous fracture. Given the availability of pharmaceuticals that decrease the fracture risk dramatically within the first 18 months of therapy, the average four to six years time between minor and hip fracture represents a perfect window of opportunity for preventive treatment.

Osteoporotic fractures, especially hip fractures, represent a major health problem in terms of morbidity, mortality and cost. Since the availability of new treatments for osteoporosis, a better understanding of the disease is needed to define the indications for treatment.

A descriptive study of osteoporotic fractures and the evaluation of the relative risk of hip fracture following a minor fracture were done on a population aged fortyfive years old and older from 1980 to 1997 (2.5 million individuals).

During the follow-up period, 220,120 fractures (hip, wrist, proximal humerus and ankle) were recorded. Wrist fractures were the most frequent (42.2%) followed by hip fractures (32.5%). Although the proportions of fracture sites were similar for both sexes, 75% of the fractures occurred in females. The mortality rate 1 year after a hip fracture is increased by 14–27% for men and 9–13% for women. Men and women aged fortyfive years old and older have a risk for hip fracture after a humerus or a wrist fracture of 2.3–17.3 time the risk of people without previous fracture. The average time between a wrist or humerus fracture and a hip fracture was four to six years.

Wrist and humerus fractures represent a major risk for future hip fracture. Given the availability of pharmaceuticals that decrease the risk of hip fracture dramatically within the first eighteen months of therapy, the interval between minor and hip fracture represents a perfect window of opportunity for preventive treatment to decrease the risk of future hip fracture.