Conclusions All interventions produced positive effects on BMD scanning and osteoporosis treatment rates post-fracture .
Despite sizeable increases , investigation and treatment rates remain sub-optimal .
Background There is a large quality of care gap for patients with osteoporosis .
As a fragility fracture is a strong indicator of underlying osteoporosis , it offers an ideal opportunity to initiate investigation and treatment .
However , studies of post-fracture population s document screening and treatment rates below 20 % in most setting s. This is despite the fact that bone mineral density ( BMD ) scans are effective at identifying patients at high risk of fracture , and effective drug treatments are widely available .
Effective interventions are required to remedy this incongruity in current practice .
Bone density at various sites for prediction of hip fractures
Women with low bone density in the radius or calcaneus are at increased risk of  hip fracture . To see whether bone density of the hip measured by dual X-ray absorptiometry is a better predictor of hip fracture than measurements of other bones , we assessed bone density at several sites in 8134 women aged 65 years or more . 65 women had hip fractures during a mean follow-up of 1.8 years . Each SD decrease in femoral neck bone density increased the age-adjusted risk of hip fracture 2.6 times ( 95 % CL 1.9 , 3.6 ) . Women with bone density in the lowest quartile had an 8.5-fold greater risk of hip fracture than those in the highest quartile . Bone density of the femoral neck was a better predictor than measurements of the spine ( p < 0.0001 ) , radius ( p < 0.002 ) , and moderately better than the calcaneus ( p = 0.10 ) . Low hip bone density is a stronger predictor of hip fracture than bone density at other sites . Efforts to prevent hip fractures should focus on women with low hip bone density
Conclusions All interventions produced positive effects on BMD scanning and osteoporosis treatment rates post-fracture .
Despite sizeable increases , investigation and treatment rates remain sub-optimal .
Background There is a large quality of care gap for patients with osteoporosis .
As a fragility fracture is a strong indicator of underlying osteoporosis , it offers an ideal opportunity to initiate investigation and treatment .
However , studies of post-fracture population s document screening and treatment rates below 20 % in most setting s. This is despite the fact that bone mineral density ( BMD ) scans are effective at identifying patients at high risk of fracture , and effective drug treatments are widely available .
Effective interventions are required to remedy this incongruity in current practice .