Incidence, risk factors, prognosis of periprosthetic fractures post hip fracture: unveiling protective role of anti-osteoporotic medication

Shao-Wei Lo; Hung-Kuan Yen; Chi-Ching Huang; Yi-Chien Lu; Ho-Min Chen; Jou-Wei Lin; Shau-Huai Fu; Chen-Yu Wang

doi:10.1007/s00198-025-07670-3

Incidence, risk factors, prognosis of periprosthetic fractures post hip fracture: unveiling protective role of anti-osteoporotic medication

Osteoporos Int. 2025 Sep 8. doi: 10.1007/s00198-025-07670-3. Online ahead of print.

Authors

Shao-Wei Lo^#¹, Hung-Kuan Yen^#², Chi-Ching Huang³, Yi-Chien Lu⁴, Ho-Min Chen⁵, Jou-Wei Lin⁶, Shau-Huai Fu^#^{7

8}, Chen-Yu Wang^#^{9

10}

Affiliations

¹ Harvard T.H. Chan School of Public Health, Boston, MA, USA.
² Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
³ Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
⁴ National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, Taiwan.
⁵ Health Data Research Center, National Taiwan University, Taipei, Taiwan.
⁶ Cardiovascular Center, National Taiwan University Hospital Yun Lin Branch, Douliu, Yunlin, Taiwan.
⁷ Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan. b90401045@gmail.com.
⁸ Department of Orthopedic Surgery, National Taiwan University Hospital Yun Lin Branch, Yunlin, Taiwan. b90401045@gmail.com.
⁹ National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, Taiwan. valinawang0220@gmail.com.
¹⁰ Department of Pharmacy, National Taiwan University Hospital Yun Lin Branch, Douliu, Yunlin, Taiwan. valinawang0220@gmail.com.

^# Contributed equally.

PMID: 40921866
DOI: 10.1007/s00198-025-07670-3

Abstract

People with a hip fracture are prone to break the bone around the metal repair, causing severe health issues. This study found that initiating anti-osteoporotic medication soon after the first fracture halves that risk, highlighting the benefit of early osteoporosis treatment.

Background: Hip fractures pose significant clinical challenges, often leading to prolonged hospitalization, reduced quality of life, and increased risk of subsequent fractures. Periprosthetic fractures (PPFs), which occur near hip fixation devices, are particularly concerning due to their high morbidity and mortality. This study evaluates the incidence, risk factors, and outcomes of PPFs and examines whether initiating anti-osteoporotic medication (AOM) after hip fracture reduces PPF risk.

Methods: We conducted a retrospective cohort study using Taiwan's National Health Insurance Research Database, analyzing 48,082 patients with hip fractures from January 2016 to December 2018. We assessed the incidence, risk factors, and prognosis of PPFs, including mortality and subsequent major osteoporotic fractures (SMOFs), and compared these outcomes to those with contralateral second hip fractures (2HFs). The effect of AOM initiation post-hip fracture was also evaluated.

Results: Among the cohort, 443 patients (0.9%) developed PPFs, and 2285 (4.8%) experienced 2HFs. Patients aged 60-69 had a higher PPF risk. AOM use was significantly associated with reduced risk of both PPFs (HR 0.50; 95% CI, 0.39-0.65) and 2HFs (HR 0.85; 95% CI, 0.77-0.93). Five-year mortality was comparable between PPF and 2HF groups (33.0% vs. 30.0%), but SMOFs were more frequent in PPF cases (7.5% vs. 3.7%).

Conclusions: PPFs are a serious complication following hip fracture. Post-fracture AOM initiation appears to lower the risk of PPFs and 2HFs, supporting its role as a key preventive strategy. Further research is needed to optimize treatment protocols.

Keywords: Hip fractures; Osteoporotic treatments; Periprosthetic fractures; Prevention.

Abstract

Grants and funding