Few Older Adults Receive Osteoporosis Medication After Hip Fracture, Study Shows

The review highlighted that beginning anti-osteoporosis medication (AOM) in this setting is shaped by a two-step process: first, whether treatment is addressed by healthcare professionals, and second, how it is discussed with patients. These steps, the researchers suggest, help explain why prescription rates remain low. Strengthening both professional initiative and patient awareness could be key to improving care.

Sabine de Jong-Holthuijsen and colleagues from the Department of Public Health and Primary Care at Leiden University Medical Center, the Netherlands, conducted the review. The team synthesised data from qualitative studies exploring the experiences of both patients and clinicians with initiating osteoporosis therapy after hip fractures in older adults. “We aimed to better understand why, despite proven benefits, so many patients miss out on recommended treatment,” said the authors.

To achieve this, the researchers performed a systematic search across seven medical databases and applied a thematic synthesis method. Twenty studies were included in the analysis. Rigour was ensured using the CASP checklist and the GRADE-CERQual approach. From this, two overarching themes with eight subthemes emerged, offering insight into the decision-making process.

The first theme, referred to as the “addressing step,” showed that initiating osteoporosis treatment is not straightforward. It depends heavily on specialty-specific roles, clinicians’ knowledge and capacity, and their willingness to identify eligible patients. The decision was also influenced by how important and feasible treatment was considered within a given clinical context.

The second theme, the “discussing step,” highlighted the complexities of conversations between patients and healthcare providers. Effective initiation required raising awareness through education, ensuring patients understood the purpose of treatment, adopting a patient-centred approach, and supporting patient choice. However, these discussions were rarely linear or simple, highlighting the challenges in shared decision-making.

The findings reinforce that pharmacological management of osteoporosis is strongly recommended to prevent secondary fractures following a hip fracture, yet uptake remains limited. Previous evidence shows that patients who start AOMs after a hip fracture significantly reduce their risk of subsequent complications, including periprosthetic and contralateral hip fractures. Still, many older adults never begin therapy.

According to the authors, this gap is not only an organisational problem but also reflects the attitudes and choices of both patients and clinicians. Simply issuing guidelines may not be sufficient. “Improving treatment rates will require efforts beyond system-level strategies,” they noted, pointing to the importance of education and awareness to foster both professional responsibility and patient engagement.

"The study reveals that the decision to initiate osteoporosis medication after hip fracture is far more complex than prescribing a drug. The interplay between healthcare professionals’ approaches and patients’ perceptions plays a decisive role, explaining persistently low prescription rates," the authors wrote.

"Promoting education, improving communication, and fostering shared decision-making may be vital steps to ensure more older adults receive the protection these medications can provide," they concluded.

Reference:

Ravensbergen, W. M., Achterberg, W. P., M, N., Gussekloo, J., & Poortvliet, R. K. (2025). Initiation of anti-osteoporosis medication following hip fracture in older adults: A systematic review and thematic synthesis of qualitative studies from patient and healthcare professional perspectives. Age and Ageing, 54(8). https://doi.org/10.1093/ageing/afaf237