The impact of in-hospital initiation of a surgeon-led, anti-osteoporotic medication algorithm for patients with fragility hip fractures: a quasi-experimental study
Our latest research study was published in the Archives of Orthopaedic and Trauma Surgery, 30 June 2025.
The impact of in-hospital initiation of a surgeon-led, anti-osteoporotic medication algorithm for patients with fragility hip fractures: a quasi-experimental study
by
Ioannis I. Daskalakis, Evangelos I. Kritsotakis, Johannes D. Bastian, Ioannis V. Sperelakis & Theodoros H. Tosounidis
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Abstract
Introduction
Secondary fracture prevention is essential to current hip fracture management. However, many patients are discharged without the appropriate anti-osteoporotic medication (AOM). This study aims to evaluate the impact of the implementation of an in-hospital, surgeon-led AOM algorithm on patients with fragility hip fractures. The three outcome events of interest assessed were (a) the AOM initiation (b) the persistence to medication at 2 years of follow-up and (c) the secondary fracture incidence within 2 years of AOM initiation in the treated and control groups.
Materials and methods
This was a three-arm controlled before-after quasi-experimental study. A group of hospitalized patients with low-energy hip fractures who were prescribed AOM according to the surgeon-led AO algorithm between March 2020 and May 2022, were compared with a group of concurrent control patients who refused the treatment over the same 2 year period, and a group of historical control patients who were hospitalized for hip fragility fractures in 2 years before the algorithm was introduced (February 2018 to February 2020). AOM initiation rates, 2 year medication persistence, and risks of secondary osteoporotic fracture were assessed and compared between groups.
Results
In this study, we enrolled 598 patients (mean age 82 ± 8 years, 78% female). Post-fracture AOM initiation increased from 15% (41/281) before to 67% (213/317) after introducing the algorithm. Medication persistence after 2 years of AOM initiation was 56% (95% confidence interval [CI] 49–63%) in treated patients and 52% (95% CI 36–66%) in historical controls. Secondary osteoporotic fractures occurred in 15/213 (7%) treated patients, 8/104 (8%) concurrent control patients, and 20/281 (7%) historical-control patients over an average follow-up of 20.4 months. Multivariable Cox regression analysis did not demonstrate significantly different fracture risks in historical controls (cause-specific hazard ratio [csHR] 0.92; 95%CI 0.45–1.89) or concurrent controls (csHR 1.08; 95% CI 0.45–2.57) compared to treated patients.
Conclusion
The AO Foundation algorithm can increase AOM initiation at hospital discharge, retaining high medication persistence 2 years post-fracture. A longer follow-up period is required to evaluate the algorithm's effect on secondary fracture prevention.
Figure 1. Study flowchart of the study design and patient enrollment
Figure 3. Cumulative incidence function plots of secondary fractures and deaths following hospital discharge in relation to anti-osteoporotic treatment