Researchers looked at over 1,100 seniors who had surgery for hip fractures to see if doctors were treating their weak bones fairly. They checked whether patients’ race, language spoken at home, or income level affected whether they got vitamin D tests and bone-strengthening treatment. The good news: most patients got similar care regardless of these factors. However, the study found that Black patients and those from poorer neighborhoods were less likely to see a bone specialist doctor during their hospital stay. This suggests that while basic bone care is being given equally, some patients aren’t getting the extra expert attention that could help prevent future fractures.

The Quick Take

  • What they studied: Whether older adults received fair and equal treatment for weak bones after hip fractures, and whether their race, home language, or income level affected their care
  • Who participated: 1,149 people age 65 and older who had hip fracture surgery between 2020 and 2023 at major hospitals. Most were English speakers (89%) and White (90%)
  • Key finding: Most patients received similar vitamin D tests and bone treatments regardless of race, language, or income. However, Black patients and those from lower-income neighborhoods were about 30-40% less likely to see a bone specialist doctor during their hospital stay
  • What it means for you: If you or a loved one has a hip fracture, you should expect to receive bone health screening and treatment. However, this study suggests some patients may need to ask for a specialist consultation to ensure complete care

The Research Details

Researchers reviewed medical records from 1,149 patients over 65 who had hip fracture surgery at three different hospital levels between 2020 and 2023. They looked backward at what actually happened in patient care rather than following people forward in time. For each patient, they recorded their race, what language they spoke, and their neighborhood’s income level using a special poverty measurement tool. They then compared whether different groups of patients received vitamin D screening, bone-strengthening medications, and specialist doctor visits.

The hospitals included in this study were trauma centers—hospitals that specialize in treating serious injuries. By looking at multiple hospitals of different sizes, the researchers could see if patterns were consistent across different healthcare settings. This approach helps identify whether any unfair treatment patterns are widespread or just happening in one place.

After a hip fracture, checking vitamin D levels and treating weak bones is critical to prevent future fractures and help patients stay independent. If some groups of patients aren’t getting these important checks and treatments, it could lead to more fractures and worse health outcomes. Understanding whether care is being given fairly is the first step toward fixing any problems.

This study looked at real patient records from actual hospitals, which makes the findings realistic and practical. However, the study was mostly White and English-speaking patients (90% and 89%), so results may not apply equally to more diverse populations. The researchers couldn’t control for all possible reasons why doctors might recommend specialist visits, so some differences might be due to medical factors rather than unfair treatment. The study was also limited to one healthcare system, so patterns might differ elsewhere.

What the Results Show

The main finding was surprisingly positive: when researchers compared vitamin D screening rates and bone treatment rates between different racial groups, language groups, and income levels, they found no significant differences. This means that most patients—whether Black or White, English or non-English speaking, wealthy or poor—received similar basic bone health care after their hip fractures.

However, a concerning secondary finding emerged about specialist consultations. Patients who didn’t speak English as their first language were about twice as likely to see a bone specialist doctor (endocrinologist) during their hospital stay. In contrast, Black patients were about 70% less likely to see a specialist, and patients from lower-income neighborhoods were about 30% less likely. These differences were statistically significant, meaning they weren’t due to chance.

When patients did see a bone specialist, they were more likely to get vitamin D screening and bone treatment. This suggests that specialist consultations are helpful for ensuring complete care. The fact that some groups were less likely to get these consultations raises questions about whether all patients are getting equal access to expert guidance.

The study found that geriatric consultations (visits with doctors who specialize in older adults) also increased the chances that patients would receive vitamin D screening and bone treatment. This suggests that having multiple specialists involved in care improves outcomes. The study also noted that most patients had a specific type of hip fracture (intertrochanteric, 76.6%), which is important because different fracture types might need different treatment approaches.

Previous research has shown that disparities in healthcare are common, with some groups receiving less aggressive treatment than others. This study is somewhat reassuring because it shows that basic bone health care after hip fractures appears to be distributed fairly. However, it confirms concerns from other research showing that Black patients and those from lower-income areas sometimes receive fewer specialist consultations, which could affect the quality of their overall care.

The study population was mostly White (90%) and English-speaking (89%), so the findings may not apply to more diverse communities. The researchers couldn’t see why doctors recommended specialist visits, so some differences might reflect medical judgment rather than unfair treatment. The study only looked at one healthcare system, so results might differ in other hospitals or regions. Finally, the study couldn’t track what happened to patients after they left the hospital, so we don’t know if differences in specialist visits led to different long-term outcomes.

The Bottom Line

If you’re over 65 and have a hip fracture, you should expect your doctors to: (1) Check your vitamin D levels, (2) Discuss bone-strengthening medications with you, and (3) Consider a consultation with a bone specialist or geriatric doctor. If you’re not offered these, ask your doctor why. If you’re from a Black community or lower-income neighborhood, be especially proactive about requesting specialist consultations, as this study suggests you might be less likely to be offered one automatically. Confidence level: Moderate—this is based on one hospital system’s experience.

This research matters most for: (1) Older adults (65+) who have had or might have hip fractures, (2) Their family members and caregivers, (3) Doctors and hospitals treating hip fractures, and (4) Healthcare administrators working to ensure fair treatment. People under 65 with hip fractures should discuss whether these findings apply to them with their doctors.

Vitamin D screening should happen during your hospital stay or within a few weeks of surgery. If bone-strengthening treatment is recommended, it typically takes 6-12 months to see improvements in bone strength. Preventing future fractures is a long-term goal that may take 1-2 years or more to fully assess.

Want to Apply This Research?

  • Track your vitamin D levels quarterly (every 3 months) if you’re taking vitamin D supplements or bone-strengthening medications. Log the date of tests, results, and any medications prescribed. Set reminders for specialist appointments and follow-up visits.
  • If you’ve had a hip fracture, use the app to: (1) Schedule and track vitamin D and bone density screening appointments, (2) Log any bone-strengthening medications you’re taking and set daily reminders, (3) Record fall prevention activities like physical therapy or balance exercises, (4) Document specialist visits and recommendations
  • Create a long-term bone health dashboard that tracks: vitamin D levels over time, medication adherence, bone density test results (DEXA scans), fall incidents, and specialist consultation dates. Set quarterly check-in reminders to review progress and discuss results with your doctor.

This study describes patterns in how hip fracture patients were treated at specific hospitals and should not be interpreted as medical advice. If you have had a hip fracture or are at risk for one, consult with your doctor about appropriate screening and treatment for your individual situation. The findings about differences in specialist consultations suggest potential disparities but do not prove discrimination. Healthcare decisions should be made in partnership with your medical team based on your specific health needs and circumstances. This research is from one healthcare system and may not apply to all hospitals or regions.