Patients with hip fracture: what can be improved?

Hip fracture is costly from both personal and public health perspectives. Major advances in understanding the risk factors for osteoporotic fracture and in developing strategies to reduce risk have occurred in recent years. Effective interventions to reduce hip fracture risk include vitamin D and calcium supplementation, antiresorptive agents such as bisphosphonates and possibly estrogen and the anabolic agent teriparatide, fall prevention strategies, and use of hip protectors. Current clinical practice regarding hip fracture prevention, however, leaves much to be desired. Primary care physicians seeing high-risk patients must identify and manage this risk. Radiologists, orthopedic surgeons, and rehabilitation medicine physicians who diagnose and treat patients for fracture-a major risk factor for subsequent fracture-must refer patients for additional assessment and treatment to reduce risk. Appropriate risk factor assessment and use of current intervention strategies should markedly reduce the numbers of new fractures.