Osteoporosis remains a major health concern due to high incidence of fragility fractures followed by higher mortality and morbidity. Implementation of guidelines for diagnosis and treatment of osteoporosis is critically discussed internationally. Aim of this study was to evaluate implementation of these guidelines regarding diagnosis and therapy of osteoporosis in a developed western country. We hypothesized that (a) prior diagnosis of osteoporosis in patients with low-energy fractures is higher than the estimated incidence and (b) diagnosis and therapy of osteoporosis in patients with prior low-energy fractures is higher than in patients without prior low-energy fractures. 399 patients >60 years suffering low-energy-fractures of their spine, femur, humerus or forearm between 03/2014 and 04/2015 were recruited in a German trauma center. All received a standardized interview. In 21% (84/399) of all patients, osteoporosis was diagnosed prior to current admission. 34% (136/399) suffered a prior risk-fracture after age of 50. Of these, only 54% (73/136) reported about following dual-energy X-ray absorptiometry (DXA) to test for decreased bone-marrow-density with positive results in 68% (50/73). 38% (19/50) of these patients with fragility fractures and prior osteoporosis diagnosis received anti-osteoporotic medication. 66% (263/399) of all patients had no prior risk-fracture and were tested for osteoporosis by DXA in 36% (95/263), leading to positive results in 34% (32/95). 44% (14/32) of these patients received anti-osteoporotic medication. Applying FRAX, 33% of all patients showed a calculated 10-year-risk >20% for suffering a major osteoporotic fracture. 61% (83/136) of patients with a prior fracture had a 10-year-risk >20% of which 47% (39/83) patients received no prior DXA. Although guidelines recommend diagnosis and treatment of patients with low-energy fractures, opportunity for early treatment following risk fractures seems rarely used. Expedient risk assessment is necessary to indicate further diagnostics and therapy of osteoporosis to ensure adequate and efficient treatment for osteoporotic fractures.