Should patients with exceptional longevity be treated for osteoporosis after a hip fracture?

Abstract

There are no studies focusing on treatment for osteoporosis in patients with exceptional longevity after suffering a hip fracture. To assess the advisability of initiating treatment for osteoporosis after a hip fracture according to the incidence of new fragility fractures after discharge, risk factors for mortality and long-term survival. Retrospective review. A tertiary university hospital serving a population of ~425000 inhabitants in Barcelona. All patients >95years old admitted with a fragility hip fracture between December 2009 and September 2015 who survived admission were analysed until the present time. Pre-fracture ambulation ability and new fragility fractures after discharge were recorded. Risk factors for 1-year and all post-discharge mortality were calculated with multivariate Cox regression. Kaplan-Meier survival curve analyses were performed. One hundred and seventy-five patients were included. Median survival time was 1.32years [95% confidence interval (CI) 1.065-1.834], with a maximum of 9.2years. Male sex [hazard ratio (HR) 2.488, 95% CI 1.420-4.358] and worse previous ability to ambulate (HR 2.291, 95% CI 1.417-3.703) were predictors of mortality. After discharge and up to death or the present time, 10 (5.7%) patients had a new fragility fracture, half of them during the first 6months. Few new fragility fractures occurred after discharge and half of these took place in the first 6months. The decision to start treatment of osteoporosis should be individualised, bearing in mind that women and patients with better previous ambulation ability will have a better chance of survival.