Introduction: Significant evidence-to-practice gaps in osteoporosis management have led to national guidelines, the impact of which is unknown. We evaluated osteoporosis assessment and management after hospital admission to a major metropolitan centre with minimal trauma fracture (MTF) in the context of Australian osteoporosis guidelines. Method: This retrospective analysis included patients over 50 years of age who were admitted to hospital for over 48 h with MTF from 1st January to 31st December 2015. All emergency department (ED) presentations for fracture were identified by diagnosis coding, and 60% were randomly selected for hand-screening to exclude traumatic, pathological, facial and digit fractures. Data were collected from medical records, and inpatient and discharge osteoporosis management was compared to Australian guideline recommendations. Results: Of 1355 patients presenting to the ED with fracture in 2015, 805 were screened, with 272 eligible for inclusion. Median age was 83 years (IQR 73–88); 69% were female, 161 participants (59%) presented with a hip or vertebral fracture and 80 (29%) participants had a documented pre-existing osteoporosis diagnosis. Anti-resorptive medications were indicated for 189 participants according to guidelines, though were only prescribed for one-third of these patients (n = 65/189, 34%). Bone mineral density testing was warranted in a further 83 patients, and undertaken in nine (11%). Only 110 participants (40%) had the words “osteoporosis” or “osteopenia” documented in their discharge summary. Discussion: Health professionals involved in the care of hospitalised patients with MTF are still missing opportunities to prevent future harms by commencing appropriate management to reduce subsequent fracture risk.