Osteoporosis is common in elderly patients admitted to orthopaedic units with fractures. Fragility fractures place a large burden on health expenditure. Orthopaedic units are in a position to identify patients who require bone density assessment and possible treatment of osteoporosis. Previous surveys of orthopaedic surgeons have shown a wide variance in their perceived role in this.

This study was a retrospective note review of 305 patients aged over 55 years with a fragility fracture, who were admitted under the orthopaedic service of eight New Zealand hospitals. Notes from any subsequent rehabilitation unit admission were also reviewed, if available.

The mean age was 80.6 years (range 55–104). Seventy seven percent were female. The most common fracture was of the hip (61.6%). Two hundred and thirty-six patients (77.4%) were not taking osteoporosis medication at time of admission, 2.5% of these had a bone mineral density assessment ordered and 11.9% had osteoporosis treatment started, giving a combined intervention rate (investigation or treatment) of 14.4%. A visiting orthogeriatric service initiated treatment in 82.1% of cases. Osteoporosis was listed on the discharge summary in 31.8% of patients who were taking osteoporosis treatment on admission and in 10.7% of patients who had treatment started.

Management of osteoporosis is mostly neglected by New Zealand orthopaedic units. This is similar to published data from other countries. Hospitals with the highest rates of osteoporosis intervention had an orthogeriatric service initiating the majority of treatment. Treatment started by the orthopaedic staff was not optimal. Osteoporosis is not identified in most documentation generated by the orthopaedic units.