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CC BY 4.0 · Surg J (N Y) 2024; 10(01): e11-e19
DOI: 10.1055/s-0044-1779681
Original Article

The Efficiency of Antiosteoporosis Medicine after Intertrochanteric Fracture Surgery: A Retrospective Study of Refracture Rate, Function Recovery, Complications, and Mortality in the Chinese Elderly Population

Weidong Zhao
1   Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan, China
,
Shengbao Chen
2   Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
,
Chao Tang
2   Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
,
Changqing Zhang
2   Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Abstract

Objective This research aimed to discern the effects of antiosteoporosis medication on postoperative functional recovery, refracture incidence, complications, and mortality in geriatric patients with intertrochanteric fractures.

Methods A retrospective study was conducted on 250 patients aged 65 years and above who underwent surgery for intertrochanteric fractures between January 2013 and December 2014. Intertrochanteric fracture is diagnosed with International Classification of Diseases 10th Revision code (S72.101) and classified by the Evans–Jensen system. Collected data encompassed demographic details, pre- and postoperative histories of antiosteoporotic medication, functional outcomes (measured using Harris hip score, Parker Mobility Score, and EuroQol-5 Dimension [EQ-5D] scores), refracture incidences, complications, and survival rates. The antiosteoporotic regimen was categorized into essential (calcium, vitamin D) and advanced medications (bisphosphonate, calcitonin, etc.). Outcomes between patients on antiosteoporosis treatment (AO group) and those without (control group) were compared.

Results The cohort comprised 250 patients, with a gender distribution of 85 males (34%) and 165 females (66%), and a mean age of 79.8 ± 7.0 years. The median follow-up period was 15.82 months (maximum 31.13 months). Postoperatively, 126 (50.4%) patients were administered antiosteoporotic treatment. The refracture incidence in the AO group (2.4%, n = 3) was notably lower than the control group (8.9%, n = 11), manifesting a substantial risk reduction (odds ratio 0.251, 95% confidence interval 0.068–0.920, p = 0.024). While no marked differences in functional outcomes between the AO and control groups were observed (Harris score [96.17 ± 7.77 vs. 97.29 ± 6.74, p = 0.074), Parker score [8.54 ± 1.26 vs. 8.62 ± 1.18, p = 0.411], EQ-5D [0.83 ± 0.05 vs. 0.82 ± 0.06, p = 0.186]), patients administered a combination of essential and advanced drugs showcased significantly improved Harris and EQ-5D scores compared to those on essential drugs alone (Harris score [77.93 ± 2.04 vs. 84.94 ± 2.73, p = 0.015], EQ-5D [0.65 ± 0.03 vs. 0.75 ± 0.04, p = 0.015]).

Conclusion Postoperative antiosteoporosis treatment acts as a deterrent against refracture following intertrochanteric fracture surgeries, evidenced by a decline in refracture rates. However, the treatment's impact on functional recovery, quality of life, complications, and mortality remains indistinct. Interestingly, the combined administration of essential and advanced antiosteoporotic drugs seems to foster enhanced functional outcomes, warranting further exploration in future studies.

Keywords

elderly - intertrochanteric fracture - antiosteoporosis treatment - refracture

Data Availability Statement

The simulation experiment data used to support the findings of this study are available from the corresponding author upon request.




Publication History

Received: 21 September 2023

Accepted: 17 January 2024

Article published online:
12 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Brozek W, Reichardt B, Zwerina J, Dimai HP, Klaushofer K, Zwettler E. Antiresorptive therapy and risk of mortality and refracture in osteoporosis-related hip fracture: a nationwide study. Osteoporos Int 2016; 27 (01) 387-396
    CrossrefPubMedGoogle Scholar
  • 2 Marks R, Allegrante JP, Ronald MacKenzie C, Lane JM. Hip fractures among the elderly: causes, consequences and control. Ageing Res Rev 2003; 2 (01) 57-93
    CrossrefPubMedGoogle Scholar
  • 3 Tan WL, Low SL, Shen L, Das De S. Osteoporotic hip fractures: 10-year review in a Singaporean hospital. J Orthop Surg (Hong Kong) 2015; 23 (02) 150-154
    CrossrefPubMedGoogle Scholar
  • 4 Alexiou KI, Roushias A, Varitimidis SE, Malizos KN. Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging 2018; 13: 143-150
    CrossrefPubMedGoogle Scholar
  • 5 Amarilla-Donoso FJ, López-Espuela F, Roncero-Martín R. et al. Quality of life in elderly people after a hip fracture: a prospective study. Health Qual Life Outcomes 2020; 18 (01) 71
    CrossrefPubMedGoogle Scholar
  • 6 Yang T-I, Kuo Y-J, Huang S-W, Chen Y-P. Minimal short-term decline in functional performance and quality of life predicts better long-term outcomes for both in older Taiwanese adults after hip fracture surgery: a prospective study. J Orthop Surg Res 2023; 18 (01) 791
    CrossrefPubMedGoogle Scholar
  • 7 Klestil T, Röder C, Stotter C. et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep 2018; 8 (01) 13933
    CrossrefPubMedGoogle Scholar
  • 8 Wanjiang F, Xiaobo Z, Xin W, Ye M, Lihua H, Jianlong W. Application of POSSUM and P-POSSUM scores in the risk assessment of elderly hip fracture surgery: systematic review and meta-analysis. J Orthop Surg Res 2022; 17 (01) 255
    CrossrefPubMedGoogle Scholar
  • 9 Cobden A, Cobden SB, Çamurcu Y, Ucpunar H, Duman S, Sofu H. Effects of postoperative osteoporosis treatment on subsequent fracture and the 5-year survival rates after hemiarthroplasty for hip fracture. Arch Osteoporos 2019; 14 (01) 100
    CrossrefPubMedGoogle Scholar
  • 10 Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: a review. World J Orthop 2014; 5 (04) 402-411
    CrossrefPubMedGoogle Scholar
  • 11 Desai RJ, Mahesri M, Abdia Y. et al. Association of osteoporosis medication use after hip fracture with prevention of subsequent nonvertebral fractures: an instrumental variable analysis. JAMA Netw Open 2018; 1 (03) e180826
    CrossrefPubMedGoogle Scholar
  • 12 Yusuf AA, Cummings SR, Watts NB. et al. Real-world effectiveness of osteoporosis therapies for fracture reduction in post-menopausal women. Arch Osteoporos 2018; 13 (01) 33
    CrossrefPubMedGoogle Scholar
  • 13 Makridis KG, Karachalios T, Kontogeorgakos VA, Badras LS, Malizos KN. The effect of osteoporotic treatment on the functional outcome, re-fracture rate, quality of life and mortality in patients with hip fractures: a prospective functional and clinical outcome study on 520 patients. Injury 2015; 46 (02) 378-383
    CrossrefPubMedGoogle Scholar
  • 14 Frihagen F, Grotle M, Madsen JE, Wyller TB, Mowinckel P, Nordsletten L. Outcome after femoral neck fractures: a comparison of Harris Hip Score, Eq-5d and Barthel Index. Injury 2008; 39 (10) 1147-1156
    CrossrefPubMedGoogle Scholar
  • 15 Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 1993; 75 (05) 797-798
    CrossrefPubMedGoogle Scholar
  • 16 Minghui L, Nan L. A introduction of Chinese version of EuroQol (EQ-5D). China J Pharmaceut Econom 2009; (01) 49-57
    PubMedGoogle Scholar
  • 17 Hegde V, Jo JE, Andreopoulou P, Lane JM. Effect of osteoporosis medications on fracture healing. Osteoporos Int 2016; 27 (03) 861-871
    CrossrefPubMedGoogle Scholar
  • 18 Klop C, Gibson-Smith D, Elders PJ. et al. Anti-osteoporosis drug prescribing after hip fracture in the UK: 2000-2010. Osteoporos Int 2015; 26 (07) 1919-1928
    CrossrefPubMedGoogle Scholar
  • 19 Devold HM, Søgaard AJ, Tverdal A, Falch JA, Furu K, Meyer HE. Hip fracture and other predictors of anti-osteoporosis drug use in Norway. Osteoporos Int 2013; 24 (04) 1225-1233
    CrossrefPubMedGoogle Scholar
  • 20 Berry SD, Samelson EJ, Hannan MT. et al. Second hip fracture in older men and women: the Framingham Study. Arch Intern Med 2007; 167 (18) 1971-1976
    CrossrefPubMedGoogle Scholar
  • 21 Birks YF, Hildreth R, Campbell P, Sharpe C, Torgerson DJ, Watt I. Randomised controlled trial of hip protectors for the prevention of second hip fractures. Age Ageing 2003; 32 (04) 442-444
    CrossrefPubMedGoogle Scholar
  • 22 Lee YK, Ha YC, Yoon BH, Koo KH. Incidence of second hip fracture and compliant use of bisphosphonate. Osteoporos Int 2013; 24 (07) 2099-2104
    CrossrefPubMedGoogle Scholar
  • 23 Larsson S, Fazzalari NL. Anti-osteoporosis therapy and fracture healing. Arch Orthop Trauma Surg 2014; 134 (02) 291-297
    CrossrefPubMedGoogle Scholar
  • 24 Reginster JY, Neuprez A, Dardenne N, Beaudart C, Emonts P, Bruyere O. Efficacy and safety of currently marketed anti-osteoporosis medications. Best Pract Res Clin Endocrinol Metab 2014; 28 (06) 809-834
    CrossrefPubMedGoogle Scholar
  • 25 Wang X, He Y, Guo B. et al. In vivo screening for anti-osteoporotic fraction from extract of herbal formula Xianlinggubao in ovariectomized mice. PLoS One 2015; 10 (02) e0118184
    CrossrefPubMedGoogle Scholar
  • 26 Jian-min Rong, Zhi-wei Lü, Jun-jie Pi, Le-xue Fei. Effect of Xianlinggubao on osteoporotic fracture healing in rats. Chinese J Tissue Eng Res 2012; (42) 7809-7813
    PubMedGoogle Scholar
  • 27 Lee YK, Ha YC, Choi HJ. et al. Bisphosphonate use and subsequent hip fracture in South Korea. Osteoporos Int 2013; 24 (11) 2887-2892
    CrossrefPubMedGoogle Scholar
  • 28 Shen SH, Huang KC, Tsai YH. et al. Risk analysis for second hip fracture in patients after hip fracture surgery: a nationwide population-based study. J Am Med Dir Assoc 2014; 15 (10) 725-731
    CrossrefPubMedGoogle Scholar
  • 29 Seng WR, Belani MH, Ramason R, Naidu G, Doshi HK. Functional improvement in geriatric hip fractures: does vitamin D deficiency affect the functional outcome of patients with surgically treated intertrochanteric hip fractures. Geriatr Orthop Surg Rehabil 2015; 6 (03) 186-191
    CrossrefPubMedGoogle Scholar
  • 30 Knopp-Sihota JA, Newburn-Cook CV, Homik J, Cummings GG, Voaklander D. Calcitonin for treating acute and chronic pain of recent and remote osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Osteoporos Int 2012; 23 (01) 17-38
    CrossrefPubMedGoogle Scholar
  • 31 Huusko TM, Karppi P, Kautiainen H, Suominen H, Avikainen V, Sulkava R. Randomized, double-blind, clinically controlled trial of intranasal calcitonin treatment in patients with hip fracture. Calcif Tissue Int 2002; 71 (06) 478-484
    CrossrefPubMedGoogle Scholar
  • 32 Henzman C, Ong K, Lau E, Seligson D, Roberts CS, Malkani AL. Complication risk after treatment of intertrochanteric hip fractures in the Medicare population. Orthopedics 2015; 38 (09) e799-e805
    CrossrefPubMedGoogle Scholar
  • 33 Zeng X, Zhou Z, Jiang L. Analysis of complication factor after treatment of intertrochanteric fractures with gamma nail [in Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2007; 21 (01) 9-11
    PubMedGoogle Scholar
  • 34 Lamb JN, Panteli M, Pneumaticos SG, Giannoudis PV. Epidemiology of pertrochanteric fractures: our institutional experience. Eur J Trauma Emerg Surg 2014; 40 (03) 225-232
    CrossrefPubMedGoogle Scholar
  • 35 Lyles KW, Colón-Emeric CS, Magaziner JS. et al; HORIZON Recurrent Fracture Trial. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007; 357 (18) 1799-1809
    CrossrefPubMedGoogle Scholar