A Missed Opportunity? Osteoporosis Treatment Following Femoral Neck Fractures: Reducing the Risk of Secondary Hip Fracture.

Background: Hip fractures represent devastating injuries with extensive morbidity and mortality. Despite guidelines recommending osteoporosis pharmacotherapy after hip fracture, treatment rates remain low. This study sought to determine the effect of osteoporosis pharmacotherapy on the secondary hip fracture rate in patients undergoing operative treatment for femoral neck fractures (FNFx).

Methods: A large national database was queried for patients ≥ 50 years old who underwent operative fixation of FNFx between 2009 and 2022. Age, sex, comorbidities, and pharmaceutical records were collected from the database. Among the 17,128 study patients, the mean age was 79 years (range, 50 to 103), and 65% were women. Patients previously treated for osteoporosis were excluded. Kaplan-Meier and Cox proportional hazards analyses were used to compare secondary hip fracture rates in patients who were medically treated for osteoporosis within one year of index FNFx versus those who were never treated for osteoporosis. Cumulative rates of osteoporosis pharmacotherapy initiation and secondary hip fracture were determined.

Results: Treatment initiation within one year was associated with a significantly reduced hip fracture hazard at three years (HR [hazard ratio] 0.56, 95% CI [confidence interval] 0.32 to 0.95, P = 0.03), five years (HR 0.63, 95% CI 0.40 to 0.98, P = 0.04), and 10 years (HR 0.57, 95% CI 0.37 to 0.87, P = 0.01) following FNFx. Only 6.3% of study patients were initiated on osteoporosis medication within one year following FNFx. The cumulative rate of secondary hip fracture over 10 years was 5.3%.

Conclusions: Despite established guidelines, low rates of osteoporotic pharmacotherapy were seen in patients who had FNFx. Pharmacotherapy initiation within one year of FNFx was associated with a reduced rate of secondary hip fracture. In adherence to guidelines, physicians should educate patients and initiate osteoporosis treatment along with operative management of FNFx, given its association with reduced rates of subsequent hip fractures.