Risk of Subsequent Hip Fractures across Varying Treatment Patterns for Index Vertebral Compression Fractures

Area of Science:

• Orthopedics and Bone Health
• Geriatric Medicine
• Pharmacological Interventions

Background:

• Vertebral compression fractures (VCFs) are associated with significant morbidity and mortality.
• Adherence to established anti-osteoporotic treatment (AOT) guidelines remains suboptimal in VCF patients.
• Understanding subsequent hip fracture risk and AOT prescribing patterns is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the incidence of subsequent hip fractures following an index VCF.
• To analyze AOT prescribing patterns in patients with VCFs.
• To assess the influence of surgical interventions on AOT prescribing and hip fracture risk.

Main Methods:

• Retrospective cohort study using the PearlDiver database (2010-2021).
• International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes identified VCF patients.
• Propensity-matched analysis (1:3) compared hip fracture incidence based on AOT initiation post-VCF, excluding patients under 50 or with <1 year follow-up.

Main Results:

• The study included 637,701 patients, with 72.6% being female.
• Overall subsequent hip fracture incidence was 2.6% at 1 year and 12.9% long-term.
• Propensity-matched analysis revealed a higher rate of subsequent hip fractures in patients initiated on AOT post-VCF (1-year: 3.8% vs. 3.5%; all-time: 14.3% vs. 13.0%).

Conclusions:

• Initiation of AOTs after an index VCF was paradoxically associated with an increased risk of subsequent hip fractures, likely due to selection bias.
• Current osteoporosis management strategies require refinement to improve guideline adherence.
• Optimized management is essential to reduce morbidity and mortality associated with VCFs and subsequent fractures.