Impact of Combining Alfacalcidol With Proximal Femoral Nail Antirotation on Bone Mineral Density, Serum Bone Metabolites, and Inflammatory Markers in Elderly Patients With Osteoporotic Intertrochanteric Fractures.

Aim: Proximal femoral nail antirotation (PFNA) fixation remains an effective surgical method in effectively managing intertrochanteric fractures in elderly patients with osteoporosis. While postoperative anti-osteoporotic therapy is essential, only a part of the elderly patients adhere to anti-osteoporosis treatment. Therefore, this study aims to investigate the therapeutic efficacy of combining alfacalcidol (an anti-osteoporotic drug) with PFNA fixation, as well as their effects on serum bone metabolic markers and inflammatory indicators in elderly patients with osteoporotic intertrochanteric fractures.

Methods: This retrospective study recruited 140 elderly patients with osteoporosis intertrochanteric fractures who were treated at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, China, between January 2021 and January 2024. Patients were divided into two groups based on their treatment approach: a surgical group (n = 63, who received PFNA with routine postoperative care) and a combined group (n = 77, who received PFNA combined with alfacalcidol). Postoperatively, these patients were followed up for a six-month period. Fracture healing was comprehensively evaluated through functional assessment and X-ray imaging examination. Harris hip scores and bone mineral density (BMD) were assessed before surgery, and then again one month and six months after surgery. Furthermore, serum bone metabolic markers and inflammatory cytokines were evaluated preoperatively and then six months after surgery.

Results: The fracture healing time was significantly shorter in the combined group than in the surgical group (p < 0.001). Compared to the surgical group, the Harris scores in the combined group were significantly higher at one and six months postoperatively (p < 0.001, p = 0.003). Additionally, BMD in the combined group was significantly increased at six months postoperatively (p = 0.002). Serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), β-Crosslaps (β-CTX), and parathyroid hormone (PTH) were significantly lower in the combined group compared to the surgical group after surgery (p < 0.001), whereas 25-hydroxyvitamin D (25-OHD) and procollagen type I C-terminal propeptide (PICP) levels were significantly higher (p < 0.001). In the surgical group, there were 4 cases of screw migration, 2 cases of delayed healing, and 1 case of venous embedding in the lower limbs. There was 1 case of infection, 2 cases of screw migration, 1 case of delayed healing, and 2 cases of venous embedding in lower limbs in the combined group. The incidence of postoperative complications was comparable between the combined group (6/77, 7.79%) and the surgical group (7/63, 11.11%) (p = 0.501).

Conclusions: Alfacalcidol combined with PFNA provides superior therapeutic outcomes for elderly patients with osteoporotic intertrochanteric fractures. This treatment approach effectively reduces postoperative fracture healing time, enhances BMD, and promotes functional recovery of the hip joint. Additionally, it improves bone metabolism and alleviates inflammatory responses, thereby enhancing overall clinical outcomes.