Do orthopedic surgeons pay sufficient attention to osteoporosis in elderly patients with hip fragility fractures? A retrospective cohort study of a tertiary general hospital in China

Summary: Timely management of osteoporosis is vitally important for elderly patients with hip fragility fractures. Our study revealed age-related enhancements in diagnostic and therapeutic rates in this population, with notable improvements facilitated by enhanced recovery after surgery (ERAS) protocols. Heightening awareness among orthopedic surgeons regarding the importance of osteoporosis is necessary. Introduction: The implementation of standardized diagnostic and treatment protocols for osteoporosis in elderly patients with fractures has the potential to prevent subsequent fractures. This study aims to analyze the diagnosis and treatment of osteoporosis in elderly patients who have experienced hip fragility fractures over a six-year period at a single medical center. Additionally, this study assessed whether enhanced recovery after surgery (ERAS) protocols could ameliorate the diagnosis and treatment of osteoporosis in these patients. Methods: The study included patients aged 60 years or older who suffered hip fractures and were hospitalized in a tertiary general hospital in China during the years 2017-2022. The database search yielded 3,141 patients, and a determination was made regarding the proportion of patients who received a diagnosis, examination, and treatment for osteoporosis following a fracture occurrence. Results: Among these patients, 558 individuals (17.8%) were diagnosed with osteoporosis, 470 (15.0%) underwent bone mineral density scans, 532 (16.9%) had their bone turnover markers assessed, and 2,403 (76.5%) received treatment for osteoporosis. The outcomes showed significant improvement over the years as patients aged (p < 0.01). Meanwhile, among the 3,002 patients who underwent surgical treatment, the diagnosis and treatment rates of osteoporosis in patients managed by ERAS mode were significantly higher than those not managed by ERAS mode (p < 0.01). Conclusion: Orthopedic surgeons often underestimate the importance of osteoporosis in elderly patients with hip fragility fractures, which could lead to missed opportunities for timely diagnosis and proper treatment. Perioperative ERAS management can reduce the missed diagnosis and treatment rates of osteoporosis.