Treatment with denosumab reduces second hip fracture risk in elderly patients with femoral neck fractures

Background The issue of second hip fracture following surgery for a hip fracture has recently been the focus of increased research attention. The purpose of our study was to evaluate the effect of denosumab on the risk of second hip fracture following first hip fracture surgery in the elderly Chinese population. Methods This was a retrospective observation study in which patients aged 65 years and older suffering from osteoporotic femoral neck fractures between 1 January 2020 and 31 December 2021 were included. The patients were divided into two groups: denosumab group and control group. Propensity score matching (PSM) was performed to adjust between-group differences. Second hip fracture was defined as the time to the first occurrence following first hip fracture. Results A total of 259 patients were included in the analysis. After PSM, the risk of second hip fracture was significantly reduced in the denosumab group when compared with that in the control group (8.8% vs. 29.7%, hazard ratio (HR) = 0.292, 95%CI = 0.133–0.643, P <0.001). The incidence of second hip fracture was significantly lower in female patients and patients aged 65–84 years in the denosumab group than that in the control group (5.3% vs. 29.8%, HR = 0.293, 95%CI = 0.126–0.680, P  = 0.002; 6.2% vs. 22.8%, HR = 0.241, 95%CI = 0.079–0.740, P  = 0.007; respectively). Conclusions Denosumab reduced the risk of second hip fracture in elderly patients, with this reduction being especially marked in female patients and those aged 65–84 years. Patients who received denosumab following first hip fracture had a lower incidence of second hip fractures, thus emphasizing the importance of the prompt initiation of antiosteoporosis treatment in elderly patients following hip fracture.