Criteria for laboratory investigations were highly variable between Alvocidib cell line FLSs and were performed according to age, gender, and BMD as criteria. This variability can be the result of the lack of specific guidelines on the role of laboratory investigations in fracture patients [12]; PCI 32765 however,

several studies indicate that contributors to secondary osteoporosis are often present in patients with osteoporosis, with and without a history of recent fracture [19, 20]. Clearly, more data are necessary about the prevalence of contributors to secondary osteoporosis and bone loss in fracture patients with and without osteoporosis to specify which laboratory examinations should be performed. The age and sex of patients and fracture location were significantly different between FLSs, but less significant from a clinical point of view (differences of 4.5 years for age, 5.7% for females, 4.7% for major fractures), indicating that patient selection was quite similar between FLSs. Of interest is the finding that most fractures resulted from a fall (77.2%) Baf-A1 in vitro and a minority as a result of a traffic or sport accident, as found by others [20]. In spite of the exclusion of HET, 11% to 27% of traffic accidents were still interpreted as a low-energy trauma. There is a need to specify which traumas are considered minor or major. On the one hand, the definition of ‘fragility’

or ‘osteoporotic’ fractures is heterogeneous in the literature [21]. On the other hand, however, high-energy trauma fractures are as predictive for

subsequent fracture risk as low-trauma fractures [22]. In addition, a 5-year subsequent fracture risk is similar after a finger or hip fracture but a 5-year mortality is different, being higher after a hip fracture than after a finger fracture [10]. Thus, in the context of case findings of subsequent fracture risk in patients with a recent fracture, there is presumably no need for distinction between high- and low-energy fractures and fracture acetylcholine locations. Prevalence There was a high variability in the reporting of several CRFs between FLSs. The reason for this is unclear. For example for immobility, the variance between centres was very high and could reflect the absence of a clear definition of this CRF in the guideline [12]. Clearly, to prevent confusion about definitions in daily practice, risk factors should be specified as concrete as possible in guidelines. Differences between FLSs were also found in T-scores and fall risks of the included patients per centre. In our study, the range of prevalence of osteoporosis was 22.2% to 40.7% between centres and for fall risk (fracture due to fall from standing height or less) 51.0% to 91.1%. Presumably, not all centres had the same interest of formally evaluating fall risk or did not include such evaluation in their protocol, in spite of a guideline on fall prevention in the Netherlands.