Osteoporosis documentation following hip fracture: a retrospective cohort study from a tertiary hospital

Background: Hip fractures are among the most common consequences of osteoporosis, yet adequate diagnosis in medical records remains suboptimal, and translation of documented osteoporosis into pharmacologic therapy is often incomplete. This study evaluated whether integration of a dedicated nurse practitioner into the orthopedic inpatient workflow was associated with improved osteoporosis documentation following hip fracture. A secondary, exploratory aim was to examine associations between documentation and downstream clinical outcomes. Methods: Data were extracted from the MDClone big data platform (ADAMS), and included patients aged ≥ 60 hospitalized with ICD-10 coded hip fractures between 2007-2024. Results: The cohort comprised 6,933 patients, of whom 4,405 (63.5%) were women, with a mean age of 81.3 years. A total of 4,150 patients (59.8%) were discharged with a diagnosis of osteoporosis or osteoporotic fracture. A sustained increase in documentation rates was observed after 2015, coinciding with the integration of a nurse practitioner into inpatient care. Recorded use of anti-osteoporosis pharmacologic therapy was low and similar between groups. No consistent differences were observed in secondary clinical outcomes. Conclusions: The rate of osteoporosis documentation following hip fractures was substantially higher than reported in the literature from centers without fracture liaison services. Integration of a dedicated nurse practitioner into the orthopedic inpatient workflow was associated with a significant and sustained improvement in osteoporosis documentation. These findings highlight the potential of targeted inpatient interventions to improve post-fracture osteoporosis recognition and documentation. Trial registration: Not applicable. This is a retrospective observational study.