OBJECTIVE: To examine the trend in clinical management of patients with fragile fractures before and after the implementation of the Health Plan Employer Data and Information Set (HEDIS) osteoporosis measure. METHODS: Two cohorts of Medicare Beneficiaries with continuous enrollment for at least 18 months and a fracture during the measurement year and no use of osteoporosis medication or BMD screening in the preceding 12 months were identified in the MarketScan Medicare Supplemental and COB database for the measurement years 2000-2005. Per HEDIS, each measurement year began on July 1st of the preceding year and continues through June 30th of the measurement year. The first cohort consisted of women aged 67 and older, while the second cohort consisted of men and women aged 65 and older. Fractures were identified according to HEDIS definitions. Clinical management was assessed by the presence of a claim for BMD screening and/or a prescription for a bisphosphonate or other osteoporosis-specific medication in the year following the fracture. Adjusted rates of change in screening and treatment were estimated using multivariate logistic regression. RESULTS: In the measurement year 2000, 8.4% of Cohort 1 underwent BMD screening and 11.2% received pharmacological treatment. For Cohort 2, the rates were 6.5% and 8.3%, respectively. By 2005, BMD screening had increased by 21% and treatment increased by 15% for Cohort 1. For Cohort 2, the rates increased by 42% and 22%, respectively. After adjusting for patient age, sex, fracture location, provider specialty, geographic region and capitated versus non-capitated health plan, the rates for screening and treatment had increased by 21% and 15% for Cohort 1, and by 41% and 15% for Cohort 2. CONCLUSION: While slow progress has been made in the clinical management of fracture since the implementation of the HEDIS osteoporosis measure, there is still an opportunity for significant improvement.