Background/Purpose: Hip fracture is the second most common osteoporotic fracture and the one with the highest socio-economic cost. It is associated with high morbidity and mortality rates, reaching a mortality rate of 30% in the first year. It should be noted that the presence of a fracture with an osteoporotic profile is one of the most important risk factors for the appearance of new fractures. Despite this, less than 25% initiate treatment for osteoporosis (OP). These data reflect the importance of applying both primary and secondary prevention measures, as well as the creation of fracture units (FU). With this study we want to evaluate the need to establish a fracture unit as well as a system of referral to rheumatology after the existence of a fragility fracture. And secondly, to analyse the clinical-epidemiological characteristics of a cohort of patients with a history of osteoporotic hip fracture.

Methods: A descriptive, observational and retrospective study was conducted at the Santa Lucia hospital in Cartagena. Individuals with osteoporotic hip fracture were included from January 2017 to January 2023. A total of 28 clinical-epidemiological variables were collected and a statistical analysis was carried out using SPSSv21.

Results: 615 patients were collected, 72.8% of whom were women and 27.2% men. The mean age was 81 ±10.5 years. 72.5% were hypertensive, 41.5% were dyslipidaemic and 68.8% diabetic. 17.8% were diagnosed with chronic kidney disease , with stage 3 being the most frequent. 2.27% of the individuals who suffered a hip fracture had previously been prescribed osteoporotic treatment, despite the fact that 22.1% of them had a history of previous osteoporotic. 11.9% were taking calcium and vitamin D supplements and none underwent a densitometric study. After the hip fracture, 38.3% started calcium and vitamin D supplements and 11.8% osteoporotic treatment. 24.3% of the individuals suffered a new osteoporotic fracture, the most frequent location being at the vertebral level followed by the hip. Of the patients who suffered new fractures, 76.69% were not receiving osteoporotic treatment. Mortality during hospital admission was 6.8%, at one year it was 23.6%, at 3 years 39.7% and at 5 years 43.8% of the individuals. When we analysed mortality according to the establishment of osteoporotic treatment after hip fracture, we found a mortality rate of 28.3% in those in whom osteoporotic treatment was established, rising to 45.8% when it was not, these differences being statistically significant (p=0.21). It should be noted that only 3.1% of the individuals had been referred to rheumatology.

Conclusion: Osteoporotic treatment had been prescribed in only 2.27% of the cases, despite the fact that 22.1% of the individuals had already suffered a previous fragility fracture. After the hip fracture, osteoporotic treatment was initiated in 11.8% of the individuals, finding in these individuals a lower mortality at 5 years compared to those in whom it was not initiated. Bearing these data in mind, it would be advisable to set up a fracture unit for the assessment of osteoporotic treatment by a doctor with expertise in bone metabolism, as well as the establishment of a referral system after suffering a fracture of this type.

Table 1. Summary of the percentage of individuals with osteoporotic treatment and supplements before and after suffering an osteoporotic hip fracture (OP: osteoporosis, Ca/VitD; calcium/vitamin D).

Table 2. Summary of epidemiological, clinical and therapeutic characteristics of patients who suffered an osteoporotic femoral neck fracture.

Table 3. Percentage of mortality at 5 years according to having received osteporotic treatment after hip fracture (OP: osteoporosis).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-rate-in-patients-with-hip-fracture-is-it-recommendable-to-establish-fracture-units/