Postoperative osteoporosis therapy and risk of re-fracture in elderly patients with hip fractures: a multicenter...

This multicenter retrospective cohort study investigated the impact of guideline-concordant osteoporosis therapy on refracture risk and the timing of contralateral hip fractures in elderly patients following hip fracture surgery.

To evaluate whether osteoporosis treatment reduces the risk of subsequent fractures and prolongs the interval between initial and contralateral hip fractures in older adults.

Patients aged ≥ 65 years who underwent hip fracture surgery between January 2010 and December 2024 at three teaching hospitals were included. Patients were assigned to treatment or no treatment groups based on whether they received guideline-recommended osteoporosis therapy postoperatively. Propensity score matching (1:1) adjusted for baseline differences. Refracture risk was assessed using Kaplan-Meier analysis and Cox regression. A sub-cohort analysis examined the time to contralateral hip fracture in patients with bilateral fractures.

After matching, 1986 patients were included in the primary analysis. The osteoporosis treatment group had a significantly lower refracture rate (22.6% vs. 39.3%, p < 0.001) and longer median refracture-free survival (42 vs. 26 months, p < 0.001). Osteoporosis therapy was associated with an 89% relative reduction in refracture risk (HR = 0.11, 95% CI: 0.07-0.18, p < 0.001). Among 192 patients with bilateral hip fractures, the time to contralateral fracture was significantly longer in the osteoporosis treatment group (40.5 vs. 27.0 months, p < 0.001).

Postoperative osteoporosis therapy significantly lowers refracture risk and delays contralateral hip fracture. Integrating such treatment into routine postoperative care is essential for effective secondary fracture prevention.