Next Article in Journal
Evaluating the Efficacy of a Novel Titanium Cage System in ALIF and LLIF: A Retrospective Clinical and Radiographic Analysis
Previous Article in Journal
The Role of Physical Examination in Assessing Hip Migration in Children with Cerebral Palsy
Previous Article in Special Issue
Malnutrition in Older Hip Fracture Patients: Prevalence, Pathophysiology, Clinical Outcomes, and Treatment—A Systematic Review
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 14
Issue 16
10.3390/jcm14165816
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Systematic Review

Time Is Bone: Missed Opportunities for Secondary Prevention After a Hip Fracture

by
Ioannis I. Daskalakis
1,
Johannes D. Bastian
2 and
Theodoros H. Tosounidis
1,*
1
Department of Orthopaedic Surgery, Medical School, University Hospital of Heraklion, University of Crete, 71110 Heraklion, Greece
2
Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(16), 5816; https://doi.org/10.3390/jcm14165816
Submission received: 22 July 2025 / Revised: 15 August 2025 / Accepted: 16 August 2025 / Published: 17 August 2025
(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)
Browse Figures
Versions Notes

Abstract

Background/Objectives: Early evaluation and treatment of osteoporosis following a hip fracture is of paramount importance for secondary fracture prevention. Nevertheless, the extent to which osteoporosis management is documented in studies reporting on operatively treated hip fractures in elderly patients is unclear. This study is the first systematic review aiming to investigate and summarize the reporting of osteoporosis management in studies with operatively treated hip fractures in elderly patients. Methods: This systematic review was conducted in compliance with PRISMA guidelines. A comprehensive search within the last decade of PubMed, Embase, Cochrane Library, Web of Science, and Ovid was performed. Studies reporting on operatively treated hip fractures in patients older than 65 years of age were included. Two reviewers independently screened the studies and performed data extraction. A subsequent descriptive synthesis was performed. Results: Eighty-six (86) articles were included in this study. Osteoporosis management was reported in only twelve (12) studies. Only six (6) of them were conducted in institutions with established orthogeriatric care. Conclusions: Osteoporosis management is underreported in studies involving operatively treated hip fracture patients. This reflects a significant gap in the overall reporting of secondary fracture prevention actions. Consequently, we advocate for both (a) clinical vigilance for adherence to best practice related to osteoporosis management after the first hip fracture and reporting of the results and (b) the research focusing on the outcomes of secondary fracture prevention efforts.

1. Introduction

Hip fractures constitute a major global healthcare problem, particularly for elderly adults, due to their high rates of morbidity, mortality, and healthcare costs [1], ranking among the 10 most common causes of global disability [2]. Patients with a fragility fracture deprived of appropriate subsequent osteoporosis management have more than an 85% increased risk of suffering a secondary fracture [3], with secondary fractures occurring in approximately one-third and three-quarters of patients within one and five years [4]. Multiple clinical guidelines strongly recommend the early assessment and initiation of anti-osteoporotic therapy following a hip fracture [5]. Nevertheless, osteoporosis treatment rates remain low, and less than a third of hip fracture patients receive appropriate anti-osteoporotic medication after a hip fracture [6].
It was our impression that the documentation of the overall handling of osteoporosis in studies reporting on the surgical management of hip fractures in elderly patients was very poor in the contemporary literature. This lack of such reporting significantly impedes our understanding of real-world practices and limits efforts to improve secondary prevention strategies. The primary aim of this systematic review is to assess the extent to which osteoporosis management is reported in studies involving operatively treated older hip fracture patients. We sought to document the following three parameters of osteoporosis evaluation and management: (a) laboratory work-up of osteoporosis, (b) initiation of therapy, and (c) referral for follow-up care.

2. Material and Methods

2.1. Search Strategy

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [7]. A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and Ovid, from March 2015 to March 2025. Search terms included (“Hip Fractures” or ‘’proximal femur fracture’’ or ‘’trochanteric fracture’’ or “femoral neck fracture” or “intertrochanteric fracture” or “subtrochanteric fracture”) and (“Surgical Procedures, Operative” or surgery or surgical treatment or operative treatment or “internal fixation” “arthroplasty” or “hip replacement” OR “nailing” or “plate fixation”) and “elderly” or “older adults” or “geriatric”. The search strategy is shown in Figure 1, using PubMed as an example.

2.2. Inclusion and Exclusion Criteria

Inclusion criteria: studies involving patients aged ≥65 years who received surgical treatment for hip fractures. Randomized controlled studies and prospective and retrospective cohort studies were included.
Exclusion criteria: (1) studies that did not directly assess outcomes following the operative management of hip fracture, (2) studies that included patients younger than 65 years, (3) studies with unextractable data, (4) studies specifically investigating the effectiveness of osteoporosis management mechanisms, such as the fracture liaison service (FLS) or other specific osteoporosis management systems, (5) and non-English-language publications.

2.3. Study Selection

Two independent researchers (ID and JD) screened for potentially relevant studies by reviewing the titles and abstracts. The full texts were then screened further according to the inclusion and exclusion criteria. Any uncertainty was solved by a third researcher (TT).

2.4. Data Extraction

Two researchers (ID and JD) independently extracted and recorded the following information from the enrolled studies: author, year, country, sample size, sex, mean age, type of study, outcomes of interest, level of evidence, and report of osteoporosis management. Two investigators independently collected the data, and any discrepancies were resolved by a joint discussion or by a third investigator’s advice (TT).

2.5. Data Synthesis and Analysis

A narrative synthesis of the findings was conducted. Due to heterogeneity in study designs, reporting methods, and time frames, a meta-analysis could not be performed. Descriptive statistics were used to summarize the rates of osteoporosis management reporting across studies.

3. Results

3.1. Flow and Characteristics of Included Studies

Eighty-six (86) articles [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93] were included in this study. A total of 22 articles (25%) were published in orthopedic surgery, 4 (5%) in general surgery, and 12 (14%) in trauma journals. Forty-five (52%) were published in journals with other primary areas of focus. Seventy-two articles (84%) listed an orthopedic surgeon as either the first or last author. Seventy (70) studies (82%) were conducted in orthopedic surgery departments. The flow diagram of the included studies is shown in Figure 2. The characteristics of the studies are summarized in Table 1.

3.2. Reporting of Osteoporosis Management

Only 12 (14%) of the total 86 studies reported some facet of osteoporosis management following hip fracture surgery (Figure 3, Table S1). More specifically, the following parameters were reported: Screening for osteoporosis risk factors in 2 studies [36,48], blood test assessment in 3 studies [20,48,53], bone mineral density (BMD) testing in 5 studies [20,53,71,72,92], supplementation with calcium and/or vitamin D in 6 studies [20,53,70,72,92], initiation of anti-osteoporotic medication (e.g., bisphosphonates) in 7 studies [20,53,59,61,64,72,92], referral to fracture liaison services in 1 study [20], and referral to general practitioner reported in 1 study [36].

3.3. Trends in Reporting

Half (6) of the 12 studies that reported on osteoporosis management originated from institutions with established orthogeriatric programs [20,36,48,59,64,72]. Despite this observation, no clear geographic trend was identified, due to the limited number of reporting studies, combined with variability in study design, population characteristics, and healthcare system structures. Notably, the studies by Civinini et al. [20] and Prieto-Alhambra et al. [53] provided the most comprehensive and detailed reports of osteoporosis management, as specific diagnostic pathways were described, along with their results and final treatment rates.

3.4. Non-Reporting Studies

In the remaining 74 studies, representing 86.1% of the total included studies, there was an absence of reporting related to osteoporosis diagnosis, management, or follow-up care. These studies primarily concentrated on evaluating clinical outcomes following surgical intervention. Key outcome measures consistently reported included surgical success rates, patient mortality, functional recovery parameters, such as mobility scores or activities of daily living, and the incidence of postoperative complications, including infections and implant failures.
Secondary fracture prevention strategies were not included in the reported protocols or outcomes of the studies. There was no documented assessment of bone mineral density testing, osteoporosis screening, pharmacologic treatment initiation, or referral to osteoporosis management services following discharge. Furthermore, follow-up care was predominantly described in terms of rehabilitation progress and complication management, without a description of secondary fracture prevention measures.

4. Discussion

Hip fractures in older adults represent a major cause of morbidity and mortality and are often the result of underlying osteoporosis. Even though the guidelines recommend systematic evaluation and treatment of osteoporosis after a fragility fracture [5,94], this is not always the case and consequently, a major gap in the overall management of these devastating injuries is observed. The goal of this systematic review was to assess the frequency of any form of osteoporosis management report in studies involving patients undergoing surgical treatment for hip fractures, to offer better comprehension of the current status of secondary fracture prevention efforts reporting rates in this high-risk population.
According to our study results, only 12 of the total 86 studies included in this review (14%) reported some aspect of osteoporosis management. Reports included different aspects of osteoporosis management, such as assessment of risk factors, bone mineral density testing, supplementation with calcium and vitamin D, initiation of anti-osteoporotic treatment, or a combination of these. A detailed description of the osteoporosis pathway was provided in three studies. These findings indicate that when osteoporosis management is not involved in the research question, it is typically not reported, even in studies involving hip fractures, which are the most significant osteoporotic fractures. The above findings demonstrate that the majority of the contemporary clinical research on surgical hip management documents insufficiently every facet of secondary fracture prevention. Six of twelve studies that reported osteoporosis management originated from institutions with orthogeriatric care programs, demonstrating that integrated care programs can significantly improve awareness of secondary fracture prevention not only through clinical interventions but also by accurate reporting of osteoporosis management, and therefore directly contribute to focused efforts and strategic initiatives.
Our findings are consistent with the previous research that shows persistent undertreatment of osteoporosis in fracture care. Low rates of osteoporosis treatment initiation after hip fractures have been reported in a substantial number of studies [95]. Kim et al. reported that less than a third of hip fracture patients receive appropriate anti-osteoporotic medication [6], a finding that has been confirmed in multiple studies [96,97]. Underreporting of osteoporosis management is not only a clinical issue but also a significant research gap, particularly in the orthopedic trauma literature, where secondary fracture prevention is often overlooked unless it constitutes the primary focus of the study. Insufficient secondary fracture prevention is most often the result of fragmented care and insufficient interdisciplinary collaboration [3,98]. Integrated care programs, such as orthogeriatric care, have been associated with higher rates of diagnosing osteoporosis, initiation of calcium and vitamin D supplements, and anti-osteoporosis medication [99]. The results of our review are in line with this finding, as half of the studies (6 of 12) that reported osteoporosis management originated from institutions with orthogeriatric care, demonstrating that integrated care models can not only enhance the clinical management of osteoporosis but also improve reporting rates and advance research efforts
The absence of osteoporosis reporting in surgically treated hip fracture cohorts possibly reflects missed opportunities to reinforce secondary prevention as a standard of care. Our study results identify clinical, but mostly research-related gaps and opportunities. From a clinical perspective, the need for integrated care models, such as the FLS and orthogeriatric care, which have demonstrated success in improving treatment rates and reducing re-fracture risk [100], is highlighted by the fact that osteoporosis management is more accurately reported in studies originating from orthogeriatric care units. From a research perspective, greater accountability regarding secondary fracture prevention is required: cohort studies involving fragility fractures should consistently report on osteoporosis assessment and management, even when it does not constitute the primary endpoint. Adopting this strategy would facilitate the full integration of secondary fracture prevention into orthopedic practice and establish it as a key quality indicator.
This review has some limitations. Analysis was limited to descriptive statistics without formal meta-analysis due to the heterogeneity of the included studies. Furthermore, it is possible that osteoporosis management has been performed but not explicitly reported in some studies, leading to potential underestimation. Finally, only English-language articles were included, possibly excluding relevant work from other regions. Nevertheless, to the best of our knowledge, this is the first and only effort aiming to investigate the reporting rates of osteoporosis management in studies involving patients with hip fractures.

5. Conclusions

This study is the first systematic review in the literature to provide evidence that osteoporosis management is not adequately reported in the research involving surgically treated hip fractures, when osteoporosis interventions are not included in the study objectives. This finding reveals a significant research gap in documenting secondary prevention in this high-risk population. Based on the aforementioned evidence, we advocate that ongoing and future research related to hip fractures should invariably integrate osteoporosis and secondary fracture management reporting and documentation, with specification of certain parameters and outcomes, regardless of the study’s focus. Additionally, continuous effort is necessary to promote integrated care models, such as the FLS and orthogeriatric care, and report their outcomes to improve secondary fracture prevention.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/jcm14165816/s1, Table S1: summarizes the studies that reported osteoporosis management.

Author Contributions

I.I.D.: literature search and writing of original draft; J.D.B.: literature search and writing—review and editing; T.H.T.: conceptualization and methodology, and reviewing and editing. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors on request.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Adeyemi, A.; Delhougne, G. Incidence and Economic Burden of Intertrochanteric Fracture. JBJS Open Access 2019, 4, e0045. [Google Scholar] [CrossRef]
  2. Schermann, H.; Ashkenazi, I.; Graif, N.; Ogawa, T.; Morgan, S.; Ben Tov, T.; Khoury, A.; Warschawski, Y. Would giving priority in surgery timing to the oldest patients result in lower mortality? Int. Orthop. 2022, 46, 1701–1706. [Google Scholar] [CrossRef]
  3. Kim, S.C.; Kim, M.S.; Sanfélix-Gimeno, G.; Song, H.J.; Liu, J.; Hurtado, I.; Peiró, S.; Lee, J.; Choi, N.K.; Park, B.J.; et al. Use of osteoporosis medications after hospitalization for hip fracture: Across-national study. Am. J. Med. 2015, 128, 519–526.e1. [Google Scholar] [CrossRef]
  4. Matzkin, E.G.; DeMaio, M.; Charles, J.F.; Franklin, C.C. Diagnosis and Treatment of Osteoporosis: What Orthopaedic Surgeons Need to Know. J. Am. Acad. Orthop. Surg. 2019, 27, e902–e912. [Google Scholar] [CrossRef]
  5. McLellan, A.R.; Gallacher, S.J.; Fraser, M.; McQuillian, C. The fracture liaison service: Success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos. Int. 2003, 14, 1028–1034. [Google Scholar] [CrossRef]
  6. Kanis, J.A.; Cooper, C.; Rizzoli, R.; Reginster, J.Y. Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos. Int. 2019, 30, 3–44. [Google Scholar] [CrossRef]
  7. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef] [PubMed]
  8. Abdallatif, A.G.; Sharma, A.; Mahmood, T.; Aslam, N. Complications and Outcomes of the Internal Fixation of Non-displaced Femoral Neck Fracture in Old Patients: A Two-Year Follow-Up. Cureus 2023, 15, e41391. [Google Scholar] [CrossRef] [PubMed]
  9. Adler, R.R.; Xiang, L.; Shah, S.K.; Clark, C.J.; Cooper, Z.; Mitchell, S.L.; Kim, D.H.; Hsu, J.; Sepucha, K.; Chunga, R.E.; et al. Hip Fracture Treatment and Outcomes Among Community-Dwelling People Living with Dementia. JAMA Netw. Open 2024, 7, e2413878. [Google Scholar] [CrossRef] [PubMed]
  10. Adulkasem, N.; Phinyo, P.; Khorana, J.; Pruksakorn, D.; Apivatthakakul, T. Prognostic Factors of 1-Year Postoperative Functional Outcomes of Older Patients with Intertrochanteric Fractures in Thailand: ARetrospective Cohort Study Int, J. Environ. Res. Public Health 2021, 18, 6896. [Google Scholar] [CrossRef] [PubMed]
  11. Andriollo, L.; Sangaletti, R.; Are, L.; Perticarini, L.; Benazzo, F.; Rossi, S.M.P. Uncemented hemiarthroplasty may have a role in the treatment of unstable intertrochanteric fractures in elderly patient. A survival complications and functional outcomes analysis. Int. J. Burns Trauma. 2023, 13, 126–135. [Google Scholar]
  12. Arraut, J.; Kurapatti, M.; Christensen, T.H.; Rozell, J.C.; Aggarwal, V.K.; Egol, K.A.; Schwarzkopf, R. Total hip arthroplasty for hip fractures in patients older than 80 years of age: A retrospective matched cohort study. Arch. Orthop. Trauma. Surg. 2023, 143, 1637–1642. [Google Scholar] [CrossRef]
  13. Barışhan, F.C.; Akesen, B.; Atıcı, T.; Durak, K.; Bilgen, M.S. Comparison of hemiarthroplasty and total hip arthroplasty in elderly patients with displaced femoral neck fractures. J. Int. Med. Res. 2018, 46, 2717–2730. [Google Scholar] [CrossRef]
  14. Bayon-Calatayud, M.; Benavente-Valdepeñas, A.M. Short-Term Outcomes of Interdisciplinary Hip Fracture Rehabilitation in Frail Elderly Inpatients. Rehabil. Res. Pract. 2018, 2018, 1708272. [Google Scholar] [CrossRef]
  15. Bi, C.; Zhao, Y.; Ma, Z.; Zhang, S. Comparison of Proximal Anti-Rotation Intramedullary Nail and Femoral Head Replacement for the Treatment of Femoral Intertrochanteric Fractures in Elderly Patients. Altern. Ther. Health Med. 2023, 29, 268–273. [Google Scholar]
  16. Bigoni, M.; Turati, M.; Leone, G.; Caminita, A.D.; D’Angelo, F.; Munegato, D.; Zatti, G. Internal fixation of intracapsular femoral neck fractures in elderly patients: Mortality and reoperation rate. Aging Clin. Exp. Res. 2020, 32, 1173–1178. [Google Scholar] [CrossRef] [PubMed]
  17. Blauth, M.; Joeris, A.; Rometsch, E.; Espinoza-Rebmann, K.; Wattanapanom, P.; Jarayabhand, R.; Poeze, M.; Wong, M.K.; Kwek, E.B.K.; Hegeman, J.H.; et al. Geriatric fracture centre vs. usual care after proximal femur fracture in older patients: What are the benefits? Results of a large international prospective multicentre study. BMJ Open 2021, 11, e039960. [Google Scholar] [CrossRef] [PubMed]
  18. Bűcs, G.; Dandé, Á.; Patczai, B.; Sebestyén, A.; Almási, R.; Nöt, L.G.; Wiegand, N. Bipolar hemiarthroplasty for the treatment of femoral neck fractures with minimally invasive anterior approach in elderly. Injury 2021, 52 (Suppl. 1), S37–S43. [Google Scholar] [CrossRef]
  19. Chatterji, G.; Shukla, S.; Singhania, S.; Singh, M.P.; Mohanty, S.S.; Jaiswal, A.; Mishra, D. A Prospective Study Comparing the Functional Outcome of Bipolar Hemiarthroplasty Versus Total Hip Replacement in Elderly Patients with Fracture of the Neck of Femur. Cureus 2022, 14, e29529. [Google Scholar] [CrossRef] [PubMed]
  20. Civinini, R.; Paoli, T.; Cianferotti, L.; Cartei, A.; Boccaccini, A.; Peris, A.; Brandi, M.L.; Rostagno, C.; Innocenti, M. Functional outcomes and mortality in geriatric and fragility hip fractures-results of an integrated, multidisciplinary model experienced by the “Florence hip fracture unit”. Int. Orthop. 2019, 43, 187–192. [Google Scholar] [CrossRef]
  21. Dayama, A.; Olorunfemi, O.; Greenbaum, S.; Stone, M.E., Jr.; McNelis, J. Impact of frailty on outcomes in geriatric femoral neck fracture management: An analysis of national surgical quality improvement program dataset. Int. J. Surg. 2016, 28, 185–190. [Google Scholar] [CrossRef] [PubMed]
  22. Ekinci, Y.; Gürbüz, K.; Batın, S.; Kahraman, M.; Doğar, F.; Kaya Erten, Z. A multicenter intertrochanteric fracture study in the elderly: Hemiarthroplasty versus proximal femoral nailing. Jt. Dis. Relat. Surg. 2020, 31, 209–217. [Google Scholar] [CrossRef]
  23. Fernandez, M.A.; Achten, J.; Parsons, N.; Griffin, X.L.; Png, M.E.; Gould, J.; McGibbon, A.; Costa, M.L. WHiTE5 Investigators Cemented or Uncemented Hemiarthroplasty for Intracapsular Hip Fracture. N. Engl. J. Med. 2022, 386, 521–530. [Google Scholar] [CrossRef]
  24. Guo, J.; Dong, W.; Jin, L.; Yin, Y.; Zhang, R.; Hou, Z.; Zhang, Y. Treatment of basicervical femoral neck fractures with proximal femoral nail antirotation. J. Int. Med. Res. 2019, 47, 4333–4343. [Google Scholar] [CrossRef] [PubMed]
  25. Huang, J.; Shi, Y.; Pan, W.; Wang, Z.; Dong, Y.; Bai, Y.; Wang, A.; Zhao, Y.; Zheng, J.; Lian, H. Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients. Sci. Rep. 2020, 10, 4840. [Google Scholar] [CrossRef]
  26. Garcia-Barreiro, G.; Huespe, I.; Llano, L.; Dozo, M.; Benchimol, J.A.; Rebecchi, P.; Taype, D.; Barla, J.; Sancineto, C.; Carabelli, G. Patients with trochanteric hip fractures and pre-existing osteoarthritis can be treated with nailing osteosynthesis without significant decrease in functional status. Injury 2023, 54 (Suppl. 6). [Google Scholar] [CrossRef]
  27. Gölge, U.H.; Pazarci, O.; Kılınç, S.; Nusran, G.; Kaymaz, B.; Göksel, F.; Kömürcü, E.; Bulut, O. The treatment of intertrochanteric fractures comparison of PFN and hemiarthroplasty 3-year mortality study. Acta Orthop. Belg. 2016, 82, 508–515. [Google Scholar]
  28. Iorio, R.; Iannotti, F.; Mazza, D.; Speranza, A.; Massafra, C.; Guzzini, M.; D’Arrigo, C.; Ferretti, A. Is dual cup mobility better than hemiarthroplasty in patients with dementia and femoral neck fracture? A randomized controlled trial. SICOT-J 2019, 5, 38. [Google Scholar] [CrossRef]
  29. Jonas, S.C.; Shah, R.; Al-Hadithy, N.; Norton, M.R.; Sexton, S.A.; Middleton, R.G. Displaced intracapsular neck of femur fractures in the elderly: Bipolar hemiarthroplasty may be the treatment of choice; a case control study. Injury 2015, 46, 1988–1991. [Google Scholar] [CrossRef]
  30. Ju, F.X.; Hou, R.X.; Xiong, J.; Shi, H.F.; Chen, Y.X.; Wang, J.F. Outcomes of Femoral Neck Fractures Treated with Cannulated Internal Fixation in Elderly Patients: A Long-Term Follow-Up Study. Orthop. Surg. 2020, 12, 809–818. [Google Scholar] [CrossRef] [PubMed]
  31. Karaali, E.; Çiloğlu, O. Metaphyseal vs. diaphyseal fixed-stem hemiarthroplasty in treating unstable intertrochanteric fractures in elderly patients. Ulus. Travma Acil Cerrahi Derg. 2021, 27, 104–108. [Google Scholar] [CrossRef]
  32. Kawai, M.; Tanji, A.; Nishijima, T.; Tateyama, K.; Yoda, Y.; Iizuka, A.; Kamata, Y.; Urabe, T. Association between time to surgery and 90-day mortality after hip fracture: A retrospective cohort study of 1734 cases. J. Orthop. Sci. 2018, 23, 987–991. [Google Scholar] [CrossRef] [PubMed]
  33. Khan, A.Q.; Mohammad, J.; Qamar, R.; Siddiqui, Y.S.; Sabir, A.B.; Abbas, M. Cemented unipolar or modular bipolar hemiarthroplasty for femoral neck fractures in elderly patients—Which is better? Int. J. Burn. Trauma 2021, 11, 447–455. [Google Scholar]
  34. Knauf, T.; Bücking, B.; Bargello, M.; Ploch, S.; Bliemel, C.; Knobe, M.; Ruchholtz, S.; Eschbach, D. Predictors of long-term survival after hip fractures?-5-year results of a prospective study in Germany. Arch. Osteoporos. 2019, 14, 40. [Google Scholar] [CrossRef] [PubMed]
  35. Koyuncu, Ş.; Altay, T.; Kayalı, C.; Ozan, F.; Yamak, K. Mechanical failures after fixation with proximal femoral nail and risk factors. Clin. Interv. Aging 2015, 10, 1959–1965. [Google Scholar] [CrossRef] [PubMed]
  36. Kusen, J.Q.; Schafroth, B.; Poblete, B.; van der Vet, P.C.R.; Link, B.C.; Wijdicks, F.J.G.; Babst, R.H.; Beeres, F.J.P. The implementation of a Geriatric Fracture Centre for hip fractures to reduce mortality and morbidity: An observational study. Arch. Orthop. Trauma. Surg. 2019, 139, 1705–1712. [Google Scholar] [CrossRef]
  37. Kusen, J.; van der Vet, P.; Wijdicks, F.J.; Houwert, M.; Dijkgraaf, M.; Hamaker, M.; Geraghty, O.; Verleisdonk, E.J.; van der Velde, D. Different approaches towards geriatric trauma care for hip fracture patients: An inter-hospital comparison. Eur. J. Trauma. Emerg. Surg. 2021, 47, 557–564. [Google Scholar] [CrossRef]
  38. Laubach, M.; Bläsius, F.M.; Volland, R.; Knobe, M.; Weber, C.D.; Hildebrand, F.; Pishnamaz, M. Internal fixation versus hip arthroplasty in patients with nondisplaced femoral neck fractures: Short-term results from a geriatric trauma registry. Eur. J. Trauma. Emerg. Surg. 2022, 48, 1851–1859. [Google Scholar] [CrossRef]
  39. Leonardsson, O.; Rolfson, O.; Rogmark, C. The surgical approach for hemiarthroplasty does not influence patient-reported outcome: A national survey of 2118 patients with one-year follow-up. Bone Joint J. 2016, 98-B, 542–547. [Google Scholar] [CrossRef]
  40. Li, H.; Wang, Q.; Dai, G.-G.; Peng, H. PFNA vs. DHS helical blade for elderly patients with osteoporotic femoral intertrochanteric fractures. Eur. Rev. Med. Pharmacol. Sci. 2018, 22, 1–7. [Google Scholar] [CrossRef]
  41. Liang, Y.; Liu, S.; Li, L.; Zhong, F. Proximal femoral nail antirotation versus external fixation for unstable intertrochanteric fractures in elderly patients: A randomized controlled trial. Medicine 2022, 101, e29384. [Google Scholar] [CrossRef]
  42. Liu, H.; Li, N.; Zhang, X.; He, L.; Li, D.; Li, Y.; Zhao, G.; Wu, X. Internal fixation versus hemiarthroplasty for displaced femoral neck fractures in the elderly: A cost-effectiveness analysis. Injury 2020, 51, 1346–1351. [Google Scholar] [CrossRef]
  43. Lu, Q.; Tang, G.; Zhao, X.; Guo, S.; Cai, B.; Li, Q. Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: A 5-year follow-up of randomized controlled trial. Arch. Orthop. Trauma. Surg. 2017, 137, 27–35. [Google Scholar] [CrossRef]
  44. MacLellan, C.; Faig, K.; Cooper, L.; Benjamin, S.; Shanks, J.; Flewelling, A.J.; Dutton, D.J.; McGibbon, C.; Bohnsack, A.; Wagg, J.; et al. Health Outcomes of Older Adults after a Hospitalization for a Hip Fracture. Can. Geriatr. J. 2024, 27, 290–298. [Google Scholar] [CrossRef]
  45. Mallick, A.; Jehan, S.; Omonbude, D. Outcome of surgery in neck of femur fracture patients with poor pre-fracture mobility. HIP Int. 2020, 30, 805–809. [Google Scholar] [CrossRef]
  46. Moaz, M.; Afgan, S.; Ahmad, I.; Ur Rehman, H.; Chishty, J.A.; Aslam, A.; Ibrahim, M. Cemented Modular Bipolar Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly. Cureus 2024, 16, e74604. [Google Scholar] [CrossRef] [PubMed]
  47. Moore, J.; Berney, M.; Walsh, M.; Hurson, C.; Rowan, F.; Cleary, M.; Brent, L. Intracapsular hip fractures: A comparative study of cemented and uncemented hemiarthroplasties in the Irish hip fracture database. Surgeon 2024, 22, 276–280. [Google Scholar] [CrossRef]
  48. Morris, H.; Cameron, C.; Vanderboor, C.; Nguyen, A.; Londahl, M.; Harng Chong, Y.; Navarre, P. Hip fractures in the older adult: Orthopaedic and geriatric shared care model in Southland, New Zealand-a 5-year follow-up study. BMJ Open Qual. 2023, 12, e002242. [Google Scholar] [CrossRef] [PubMed]
  49. Mukka, S.; Sjöholm, P.; Aziz, A.; Eisler, T.; Kadum, B.; Krupic, F.; Morberg, P.; Sayed-Noor, A. A cohort study comparing internal fixation for undisplaced versus hip arthroplasty for displaced femoral neck fracture in the elderly: A pilot study for a clinical trial. Pilot Feasibility Stud. 2020, 6, 98. [Google Scholar] [CrossRef] [PubMed]
  50. Okano, I.; Sawada, T.; Kushima, N.; Tachibana, T.; Inagaki, K. Treatment with Helical Blade Cephalomedullary Nail for Two-Part Basicervical Proximal Femoral Fracture in Elderly Patients: A Retrospective Observational Study. Geriatr. Orthop. Surg. Rehabil. 2017, 8, 244–251. [Google Scholar] [CrossRef]
  51. Peddamadyam, S.; Arvind Kumar, B.; Arcot, R.V.K. Functional Outcomes of Primary Hemiarthroplasty for Unstable Intertrochanteric Fractures in the Elderly: A Prospective Observational Study. Cureus 2024, 16, e54892. [Google Scholar] [CrossRef]
  52. Prestmo, A.; Saltvedt, I.; Helbostad, J.L.; Taraldsen, K.; Thingstad, P.; Lydersen, S.; Sletvold, O. Who benefits from orthogeriatric treatment? Results from the Trondheim hip-fracture trial. BMC Geriatr. 2016, 16, 49. [Google Scholar] [CrossRef]
  53. Prieto-Alhambra, D.; Reyes, C.; Sainz, M.S.; González-Macías, J.; Delgado, L.G.; Bouzón, C.A.; Gañan, S.M.; Miedes, D.M.; Vaquero-Cervino, E.; Bardaji, M.F.B. In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: The Spanish registry of osteoporotic femur fractures prospective cohort study. Arch. Osteoporos. 2018, 13, 96. [Google Scholar] [CrossRef] [PubMed]
  54. Ratanpal, A.; Kamath, K.R.; Salian, P.R.V.; Baliga, S.S.; Annappa, R.; Banerjee, S. Mortality and functional outcomes in elderly adults treated surgically by hemiarthroplasty for femoral neck fractures. SAGE Open Med. 2025, 13, 20503121241307264. [Google Scholar] [CrossRef] [PubMed]
  55. Regis, D.; Segalla, S.; Sandri, A.; Magnan, B. Cemented and uncemented stems for displaced femoral neck fracture in the elderly. Retrospective study with a minimum 1-year follow-up. Acta Biomed. 2023, 94, e2023146. [Google Scholar] [CrossRef]
  56. Sadeghi, C.; Prentice, H.A.; Okike, K.M.; Paxton, E.W. Treatment of Intertrochanteric Femur Fractures with Long versus Short Cephalomedullary Nails. Perm. J. 2020, 24, 19.229. [Google Scholar] [CrossRef]
  57. Salvesen, E.S.; Taraldsen, K.; Lønne, G.; Lydersen, S.; Lamb, S.E.; Opdal, K.; Saltvedt, I.; Johnsen, L.G. Characteristics and outcomes for hip fracture patients in an integrated orthogeriatric care model: A descriptive study of four discharge pathways with one-year follow-up. BMC Musculoskelet. Disord. 2025, 26, 184. [Google Scholar] [CrossRef]
  58. Sanderson-Jerome, C.; Hariharan, S. Outcome and Cost Evaluation of Hip Fractures in Elderly Patients at a Tertiary Care Hospital in the Caribbean. Cureus 2024, 16, e74586. [Google Scholar] [CrossRef]
  59. Schoeneberg, C.; Pass, B.; Volland, R.; Knobe, M.; Eschbach, D.; Ketter, V.; Lendemans, S.; Aigner, R. Four-month outcome after proximal femur fractures and influence of early geriatric rehabilitation: Data from the German Centres of Geriatric Trauma DGU. Arch. Osteoporos. 2021, 16, 68. [Google Scholar] [CrossRef]
  60. Schuijt, H.J.; Kusen, J.; van Hernen, J.J.; van der Vet, P.; Geraghty, O.; Smeeing, D.P.J.; van der Velde, D. Orthogeriatric Trauma Unit Improves Patient Outcomes in Geriatric Hip Fracture Patients. Geriatr. Orthop. Surg. Rehabil. 2020, 11, 2151459320949476. [Google Scholar] [CrossRef]
  61. Sun, M.; Zhang, X.; Wang, J.; Hong, Y.; Zhang, Y.; Wang, J.; Xu, D.; Yu, X.; Zhang, Y.; Zhu, H.; et al. Current status of postoperative care for elderly osteoporotic fracture patients in Jiangsu Province China: Amulticenter cross-sectional study. Int. J. Orthop. Trauma. Nurs. 2024, 55, 101136. [Google Scholar] [CrossRef] [PubMed]
  62. Sun, L.; Wang, C.; Zhang, M.; Li, X.; Zhao, B. The Surgical Timing and Prognoses of Elderly Patients with Hip Fractures: A Retrospective Analysis. Clin. Interv. Aging 2023, 18, 891–899. [Google Scholar] [CrossRef]
  63. Sun, M.; Liang, H.R.; Zhang, H.; Bai, T.; Xu, R.D.; Duan, S.Y.; Cai, Z.C. Surgical options for Evans-Jensen type IV intertrochanteric femur fractures in the elderly over 65: A comparison between total hip arthroplasty and proximal femoral nail antirotation. Front. Surg. 2024, 11, 1510094. [Google Scholar] [CrossRef] [PubMed]
  64. Solberg, L.B.; Vesterhus, E.B.; Hestnes, I.; Ahmed, M.V.; Ommundsen, N.; Westberg, M.; Frihagen, F. Comparing two different orthogeriatric models of care for hip fracture patients: An observational prospective cross-sectional study. BMJ Open Qual. 2023, 12, e002302. [Google Scholar] [CrossRef]
  65. Sniderman, J.; Vivekanantha, P.; Shah, A.; Safir, O.; Wolfstadt, J.; Kuzyk, P. Hemiarthroplasty for Unstable Intertrochanteric Hip Fractures: AMatched Cohort Study. J. Arthroplast. 2023, 38, 1522–1527. [Google Scholar] [CrossRef]
  66. Song, J.; Zhang, G.; Liang, J.; Bai, C.; Dang, X.; Wang, K.; He, C.; Liu, R. Effects of delayed hip replacement on postoperative hip function and quality of life in elderly patients with femoral neck fracture. BMC Musculoskelet. Disord. 2020, 21, 487. [Google Scholar] [CrossRef] [PubMed]
  67. Sundkvist, J.; Hulenvik, P.; Schmidt, V.; Jolbäck, P.; Sundfeldt, M.; Fischer, P.; Rogmark, C.; Juto, H.; Wolf, O.; Mukka, S. Basicervical femoral neck fractures: An observational study derived from the Swedish Fracture Register. Acta Orthop. 2024, 95, 250–255. [Google Scholar] [CrossRef]
  68. Tan, S.T.; Tan, W.P.; Jaipaul, J.; Chan, S.P.; Sathappan, S.S. Clinical outcomes and hospital length of stay in 2756 elderly patients with hip fractures: A comparison of surgical and non-surgical management. Singap. Med. J. 2017, 58, 253–257. [Google Scholar] [CrossRef]
  69. Chen, M.; Li, Y.; Yang, Y.; Zhuang, W. Analysis of the risk factors for contralateral refracture after hip fracture surgery in elderly individuals: A retrospective study. J. Orthop. Surg. Res. 2024, 19, 681. [Google Scholar] [CrossRef]
  70. Chen, C.H.; Huang, P.J.; Huang, H.T.; Lin, S.Y.; Wang, H.Y.; Fang, T.J.; Lin, Y.C.; Ho, C.J.; Lee, T.C.; Lu, Y.M.; et al. Impact of orthogeriatric care, comorbidity, and complication on 1-year mortality in surgical hip fracture patients: An observational study. Medicine 2019, 98, e17912. [Google Scholar] [CrossRef]
  71. Cho, H.M.; Lee, K. Clinical and Functional Outcomes of Treatment for Type A1 Intertrochanteric Femoral Fracture in Elderly Patients: Comparison of Dynamic Hip Screw and Proximal Femoral Nail Antirotation. Hip Pelvis 2016, 28, 232–242. [Google Scholar] [CrossRef]
  72. Lee, J.C.; Koo, K.; Wong, E.K.C.; Naqvi, R.; Wong, C.L. Impact of an orthogeriatric collaborative care model for older adults with hip fracture in a community hospital setting. Can. J. Surg. 2021, 64, E211–E217. [Google Scholar] [CrossRef]
  73. Chen, J.Y.; She, G.R.; Luo, S.M.; Wu, W.R.; Zhuang, T.F.; Huan, S.W.; Liu, N.; Zha, Z.G. Hemiarthroplasty compared with internal fixation for treatment of nondisplaced femoral neck fractures in elderly patients: A retrospective study. Injury 2020, 51, 1021–1024. [Google Scholar] [CrossRef]
  74. Takahashi, A.; Naruse, H.; Kitade, I.; Shimada, S.; Tsubokawa, M.; Kokubo, Y.; Matsumine, A. Functional outcomes after the treatment of hip fracture. PLoS ONE 2020, 15, e0236652. [Google Scholar] [CrossRef] [PubMed]
  75. Tian, R.H.; Zhang, Q.M.; Chu, F.L.; Li, X.Y.; Jiang, Z.; Han, L.; Sun, P.; Wang, H.B.; Chi, Y.L.; Wu, B. Comparison of two methods of locating proximal femoral nail anti-rotation in the treatment of femoral intertrochanteric fractures. J. Orthop. Surg. Res. 2020, 15, 108. [Google Scholar] [CrossRef] [PubMed]
  76. Tilaveridis, P.; Iliopoulos, E.; Georgoulas, P.; Drosos, G.; Ververidis, A.; Tilkeridis, K. Treating peri-trochanteric hip fractures with intramedullary nail, when a second anti-rotational screw is necessary? BMC Musculoskelet. Disord. 2023, 24, 787. [Google Scholar] [CrossRef] [PubMed]
  77. Tol, M.C.; van den Bekerom, M.P.; Sierevelt, I.N.; Hilverdink, E.F.; Raaymakers, E.L.; Goslings, J.C. Hemiarthroplasty or total hip arthroplasty for the treatment of a displaced intracapsular fracture in active elderly patients: 12-year follow-up of randomised trial. Bone Joint J. 2017, 99-B, 250–254. [Google Scholar] [CrossRef]
  78. Uzel, K.; Birinci, M.; Hakyemez, Ö.S.; Bostanci, B.; Bingöl, İ.; Öktem, U.; Ata, N.; Ülgü, M.M.; Birinci, Ş.; Karatosun, V. Comparison of Hemiarthroplasty, total hip arthroplasty, and internal fixation for hip fractures in patients over eighty years of age: Factors affecting mortality: A nationwide cohort study of fifty three thousand, four hundred and ninety five patients from Türkiye. Int. Orthop. 2025, 49, 729–736. [Google Scholar] [CrossRef]
  79. Vasu, B.K.; Ramamurthi, K.P.; Rajan, S.; George, M. Geriatric Patients with Hip Fracture: Frailty and Other Risk Factors Affecting the Outcome. Anesth. Essays Res. 2018, 12, 546–551. [Google Scholar] [CrossRef]
  80. Yu, W.; Zhang, X.; Zhu, X.; Hu, J.; Liu, Y. A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly. J. Orthop. Surg. Res. 2016, 11, 10. [Google Scholar] [CrossRef]
  81. Wang, J.; Luo, H.; Wang, Q.; Zhu, X. Analysis of the Surgical Outcomes in Elderly Patients with Hip Fractures Combined with Hemiplegia. Clin. Interv. Aging 2022, 17, 1093–1098. [Google Scholar] [CrossRef]
  82. Viganò, M.; Pennestrì, F.; Listorti, E.; Banfi, G. Proximal hip fractures in 71,920 elderly patients: Incidence, epidemiology, mortality and costs from a retrospective observational study. BMC Public Health 2023, 23, 1963. [Google Scholar] [CrossRef]
  83. Wang, H.; Pan, L.; Li, B.; Ning, T.; Liang, G.; Cao, Y. Obese elderly patients with hip fractures may have better survival outcomes after surgery. Arch. Orthop. Trauma. Surg. 2023, 143, 4793–4803. [Google Scholar] [CrossRef]
  84. Wignadasan, W.; Najefi, A.; Dewhurst, M.; Fazal, M.A. Cemented Versus Uncemented Hemiarthroplasty for Displaced Intracapsular Neck of Femur Fractures in the Elderly: Outcomes and Costings. Indian J. Orthop. 2024, 58, 716–721. [Google Scholar] [CrossRef]
  85. Xu, X.; Hu, X.; Fei, L.; Shen, S. Analysis of elderly patients with inter-trochanteric fracture and failure of postoperative internal fixation. Technol. Health Care 2025, 33, 1917–1925. [Google Scholar] [CrossRef]
  86. Yan, T.-X.; Dong, S.-J.; Ning, B.; Zhao, Y.-C. Bipolar hip arthroplasty using conjoined tendon preserving posterior lateral approach in treatment of displaced femoral neck fractures. World J. Clin. Cases 2024, 12, 1076–1083. [Google Scholar] [CrossRef] [PubMed]
  87. Yin, Z.; Hu, Q.; Zhang, B.; Yi, J.; Zhang, H.; Yin, J. Comparison of surgical efficacy between direct anterior approach and posterolateral approach in the treatment of sarcopenia with femoral neck fractures. BMC Geriatr. 2024, 24, 1021. [Google Scholar] [CrossRef]
  88. Lee, Y.K.; Won, H.; Roa, K.R.U.; Ha, Y.C.; Koo, K.H. Bipolar hemiarthroplasty using microarc oxidation-coated cementless stem in patients with unstable intertrochanteric fracture. J. Orthop. Surg. 2019, 27, 2309499019847815. [Google Scholar] [CrossRef] [PubMed]
  89. Gilmore, C.; Mayne, A.; Goodland, C.; Cassidy, R.; MacDonnell, L.; Mogey, P.; Murphy, L.; Diamond, O. Early surgery improves survival after femoral fractures in the elderly: A retrospective review of 502 fragility fractures. Injury 2024, 55, 111275. [Google Scholar] [CrossRef] [PubMed]
  90. Roll, C.; Tittel, S.; Schäfer, M.; Burkhardt, J.; Kinner, B. Continuous improvement process: Ortho-geriatric co-management of proximal femoral fractures. Arch. Orthop. Trauma. Surg. 2019, 139, 347–354. [Google Scholar] [CrossRef]
  91. Zhou, X.; Chen, M.; Yu, W.; Han, G.; Ye, J.; Zhuang, J. Uncemented versus cemented total hip arthroplasty for displaced femoral neck fractures in elderly patients with osteoporosis: A retrospective analysis. J. Int. Med. Res. 2020, 48, 300060520944663. [Google Scholar] [CrossRef]
  92. Zhou, S.; Liu, J.; Zhen, P.; Shen, W.; Chang, Y.; Zhang, H.; Zhu, Q.; Li, X. Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: A retrospective study. BMC Musculoskelet. Disord. 2019, 20, 500. [Google Scholar] [CrossRef] [PubMed]
  93. Park, J.-H.; Chung, Y.-Y.; Baek, S.-N.; Park, T.-G. Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases. Hip Pelvis 2022, 34, 79–86. [Google Scholar] [CrossRef] [PubMed]
  94. Cosman, F.; de Beur, S.J.; LeBoff, M.S.; Lewiecki, E.M.; Tanner, B.; Randall, S.; Lindsay, R. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos. Int. 2014, 25, 2359–2381. [Google Scholar] [CrossRef]
  95. Åkesson, K.E.; McGuigan, F.E.A. Closing the Osteoporosis Care Gap. Curr. Osteoporos. Rep. 2021, 19, 58–65. [Google Scholar] [CrossRef] [PubMed]
  96. Zhang, X.; Wang, Z.; Zhang, D.; Ye, D.; Zhou, Y.; Qin, J.; Zhang, Y. The prevalence and treatment rate trends of osteoporosis in postmenopausal women. PLoS ONE 2023, 18, e0290289. [Google Scholar] [CrossRef]
  97. Ross, B.J.; Lee, O.C.; Harris, M.B.; Dowd, T.C.; Savoie, F.H., 3rd; Sherman, W.F. Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures. JBJS Open Access 2021, 6, e20.00142. [Google Scholar] [CrossRef]
  98. Akesson, K.; Marsh, D.; Mitchell, P.J.; McLellan, A.R.; Stenmark, J.; Pierroz, D.D.; Kyer, C.; Cooper, C.; IOF Fracture Working Group. Capture the Fracture: A Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos. Int. 2013, 24, 2135–2152. [Google Scholar] [CrossRef]
  99. Van Camp, L.; Dejaeger, M.; Tournoy, J.; Gielen, E.; Laurent, M.R. Association of orthogeriatric care models with evaluation and treatment of osteoporosis: A systematic review and meta-analysis. Osteoporos. Int. 2020, 31, 2083–2092. [Google Scholar] [CrossRef]
  100. Yan, C.; Chen, Y.; Cao, J.; Fang, K.; Shao, L.; Luo, Y.; Yang, L. The effectiveness of fracture liaison services in patients with hip fractures: A systematic review and meta-analysis of randomized controlled trials. Heliyon 2023, 9, e20838. [Google Scholar] [CrossRef]
Jcm 14 05816 g001
Figure 1. Search strategy adopted throughout the databases; PubMed is shown in this instance.
Figure 1. Search strategy adopted throughout the databases; PubMed is shown in this instance.
Jcm 14 05816 g001
Jcm 14 05816 g002
Figure 2. Flow diagram of included studies.
Figure 2. Flow diagram of included studies.
Jcm 14 05816 g002
Jcm 14 05816 g003
Figure 3. Reporting rates of osteoporosis management.
Figure 3. Reporting rates of osteoporosis management.
Jcm 14 05816 g003
Table 1. Characteristics of included studies (BMD: bone mineral density, DXA: dual-energy X-ray absorptiometry, and NR: not reported).
Table 1. Characteristics of included studies (BMD: bone mineral density, DXA: dual-energy X-ray absorptiometry, and NR: not reported).
AuthorYearCountrySample SizeSex
(Male:Female)		Mean AgeType of StudyOutcomes of InterestLevel of EvidenceOsteoporosis Management
Abdalattif et al.
[8]		2023UK14860:8878.5RetrospectiveNon-union and AVN incidenceIIINR
Adler et al. [9]2023USA33,1429180:23,96286.1RetrospectiveMortality, delirium, hospice services, SNF admission, nursing home admissionsIIINR
Adulkasem et al. [10]2021Thailand22136:18584RetrospectivePre-injury New Mobility Score, score at the time of discharge, one year postoperative scoreIIINR
Andriollo et al.
[11]		2023Italy8620:8687.4RetrospectiveCharlson Comorbidity Index, Barthel index, Koval Grade, Mental Score, subsequent hospitalizations for surgical operations relating to the operated hipIIINR
Arraut et al. [12]2022USA11023:87Younger cohort: 67.69
Older cohort: 85.12		Retrospective matched cohortDischarge disposition, 90-days postoperative outcomesIIINR
Barışhan et al.
[13]		2018Turkey3813:25THA: 73.6
HA: 76.9		RetrospectiveClinical outcomes and mortalityIIINR
Bayon-Calatayud et al.
[14]		2018Spain5011:3984.1Prospective cohortBarthel scoreIINR
Bi et al.
[15]		2023China7228:4468.59RetrospectivePerioperative indicators, functional outcome (Harris hip score), complications
one year postoperatively		IIINR
Bigoni et al. [16]2020Italy24479:6580RetrospectiveMortality rate, complications, reoperation rateIVNR
Blauth et al. [17]2021USA28174:207Geriatric center: 81.9
Usual care: 83.9		Prospective multicenterMajor adverse effects, mortalityIINR
Bűcs et al.
[18]		2021Hungary9435:5979Prospective cohortPerioperative indicators, mobilization, length of stay, functional outcome (Harris hip score)IINR
Chatterji et al.
[19]		2022India4016:24THA: 70.28
HA: 68.5		Prospective cohortFunctional outcome (Harris hip score)IINR
Chen et al. [73] 2020China13049:81HA: 78.3
IF: 75.1		Retrospective cohortIncidence of surgical complications and reoperation,
mortality, hip joint function at the last follow-up,
perioperative parameters		IIINR
Chen et al. [70] 2019China31392:22177.6Retrospective cohort1-year mortalityIIINR
Chen et al [69]2024China458121:276No fracture: 71
Contralateral hip fracture: 84		RetrospectiveAnalysis of contralateral hip fracture risk factorsIIIAdministration of calcitriol and calcium
Cho et al.
[71]		2016China19469:125DHS: 84.2
PFNA: 81		RetrospectiveOperative time, blood loss, walking ability, Barthel index, fracture union, proximal femur shortening, complicationsIIIBMD testing (DXA)
Civinini et al. [21]2019Italy677210:46784.5Prospective cohortMortality, return to daily activities, quality of life, adherence to re-fracture prevention programsIIFLS, BMD testing and evaluation of fall and fracture within 3 months for 434 (66%) eligible patients, prescription of specific drugs and calcium ± vitamin D supplementation
in 342 (78.8%) patients
Dayama et al.
[21]		2016USA3121938:218377.34Retrospective registry study30-day morbidity and mortalityIIINR
Ekinci et al. [22]2020Turkey30881:227BHA: 78.4
PFN: 77.7		Prospective cohortSingh Index, functional outcome (Harris hip score)IINR
Fernandez et al.
[23]		2023France18140:4182.5Retrospective cohortFixation failure rate at 3 and 6 months, quality of life, Parker mobility score, Harris hip scoreIIINR
Guo et al.
[24]		2019China174:1067.6Retrospective cohortFracture union, complications, functional outcome (Harris hip score)IIINR
Huang et al. [25]2020China20253:14986RetrospectiveOperative duration, blood loss, time of weight-bearing after operation, complications, functional outcome (Harris hip score)IIINR
Garcia-Barreiro et al. [26]2023Argentina37558:31786.1RetrospectiveFunctional outcome (Parker mobility score)IIINR
Gilmore et al. [89]2024UK502137:33580.1Retrospective30-day and 1-year mortalityIIINR
Gölge et al. [27]2016Turkey20290:112HA: 78.6
PFN: 75.7		RetrospectiveMortalityIIINR
Iorio et al. [28]2019Italy6025:35HA: 83
THA: 82		Prospective randomizedDislocation rate at a minimum follow-up of 1 year, reoperation rate, time to surgery, surgical time, length of hospital stay, 30-day and 1-year mortalityINR
Jonas et al. [29]2015UK13222:88HA: 79
THA: 78		RetrospectiveFunctional outcome (Oxford Hip Score), quality of life (SF-36), complicationsIIINR
Ju et al. [30]2020China7316:5768.22RetrospectiveNecrosis of femoral head, functional outcome (Harris Hip score)IIINR
Karaali et al. [31]2021Turkey12944:85Metaphyseal fixed HA: 78
Diaphyseal fixed HA: 79		Retrospective2-year functional outcome (Harris hip score, Parker Mobility Score), mortalityIIINR
Kawaji et al. [32]2015Japan429:33Asian IMHS: 78.4
Conv. IMHS:82.3		RetrospectiveWalking ability, complicationsIIINR
Khan et al. [33]2021India8843:45Unipolar group: 67.2
Bipolar group: 66.1		Prospective randomizedRadiological outcome, functional outcome (Harris hip score)INR
Knauf et al. [34]2019Germany395109:28681ProspectiveMortalityIINR
Koyuncu et al. [35]2015Turkey15267:8576ProspectiveClinical and radiological outcomes, complicationsIINR
Kusen et al. [36]2019Switzerland32287:2252013: 86
2016: 85		Retrospective and prospective cohortPeri-operative data, postoperative outcomes and complicationsIIIOsteoporosis screening, referral to general practitioner
Kusen et al. [37]2021Switzerland752203:54986Prospective cohortMortality, complications, time to surgical intervention, hospital length of stayIIBMD testing (DEXA scan)
Laubach et al. [38]2021Germany1727584:1143Internal fixation: 81
Arthroplasty: 83		RetrospectiveΜobility, residential status, reoperation rate, HRQoL, mortalityIIINR
Lee et al. [72]2021Canada21249:163Preintervention group: 84
Postintervention group: 85		RetrospectiveLength of stay, incidence of deliriumIIIOsteoporosis assessment, prescription of calcium and vitamin D
Lee et al.
[88]		2019South Korea23449:18580.6Prospective cohortClinical outcomes (Koval’s categories for walking ability), radiographic outcomeIINR
Leonardsson et al. [39]2016Sweden2128559:156985RetrospectiveQuality of life, painIIINR
Li et al.
[40]		2018China4317:2676.5RetrospectiveFunctional outcome (Harris hip score), mobility (TUG test, Parker scoreIIINR
Liang et al.
[41]		2022China8732:55PFNA: 86.1
External fixation: 85.6		Prospective randomizedFunctional and radiographic outcomes, complicationsINR
Liu et al.
[42]		2020China15675:81HA: 78.1
Fixation: 76.2		Prospective cohortQuality of life, cost-effectivenessIINR
Lu et al.
[43]		2016China7820:68Fixation: 85.85
HA: 86.24		Prospective randomizedOperative outcome, hip functionsINR
MacLellan et al.
[44]		2024Canada659193:48982.8RetrospectiveLength of stay, discharge location, mortalityIIINR
Mallick et al.
[45]		2019UK16845:12282RetrospectiveComplications, mortalityIIINR
Moaz et al.
[46]		2024Pakistan10256:4665.4Prospective cohortFunctional outcome (Harris hip score)IINR
Moore et al.
[47]		2023Ireland7.1092.203/4.90681Retrospective registry studyPost-op
mobility, 7-day and 14-day inpatient mortality, discharge destination		IIINR
Morris et al.
[48]		2023New Zealand18146:1352011 cohort: 84.2
2017 cohort: 82.6		RetrospectiveLength of stay, postoperative complications, 30-day and 1-year mortalityIIIAssessment of risk factors, metabolic blood tests screening
Mukka et al.
[49]		2020Sweden23575:16083Prospective pilot studyFunctional outcome (Harris hip score, WOMAC), pain (PNRS)IINR
Okano et al.
[50]		2017Japan162:1486.9RetrospectiveImplant-related complicationsIIINR
Park et al.
[93]		2022Korea349:2582.68Prospective cohortOperation time, bleeding, time to walk, complicationsIINR
Peddamadyam et al.
[51]		2024India208:1271.65Prospective cohortClinical outcome, complicationsIINR
Prestmo et al. [52]2015Norway397104:29383Prospective randomized studyMobility at 4 months (SPPB)INR
Prieto-Alhambra et al.
[53]		2018Spain997232:76583.6Prospective cohortIn-patient care, complications, and 4-month mortalityIIOsteoporosis not assessed for 23.6%, assessed but treatment unnecessary for 20.5%, 14.9% awaiting an osteoporosis clinical assessment, 3.2% discharged pending a DXA scan,
prescription of anti-osteoporotic treatment at 21.4%
Ratanpai et al. [54]2025India11037:7371.3Prospective cohortFunctional outcome (modified Harris hip score and Oxford Hip Score), 1-year mortalityIINR
Regis et al. [55]2023Italy13941:98Uncemented HA: 80.1
Cemented HA: 84.3		Retrospective cohortSurgical time, overall perioperative complication rateIINR
Roll et al.
[90]		2018Germany1015275:74083.2Prospective cohortProcedural and patient outcome parametersIINR
Sadeghi et al.
[56]		2020USA55261658:3868Long nail: 80.6
Short nail: 81.2		Retrospective cohortRisks of all-cause revision and revision for periprosthetic fractureIIINR
Salvesen et al.
[57]		2025Norway398116:28283Prospective cohortSPPB, EuroQol-5-dimension and5-level, Barthel index, Lawton and Brody Instrumental Activities of Daily Living, Lawton and Brody Self-Maintenance Scale, readmission and mortalityIINR
Sanderson-Jerome
[58]		2024TTO3013:1782.0Prospective cohortTime to surgery (lead time), complications by Clavien–Dindo score, hospital length of stay and mortality, and costs of hospitalizationIINR
Schoenberg et al.
[59]		2021Germany9780 84.4Retrospective registryRate of readmission, rate of re-surgery, anti-osteoporotic therapy, housing, mortality, walking ability, and quality of life 120 days post-surgeryIIIInitiation of anti-osteoporotic medication
Schuijt et al.
[60]		2020Netherlands80657985Retrospective cohortPostoperative complications, patient mortality, time spent at the emergency department, time to surgery, hospital length of stayIIINR
Sun et al.
[62]		2023China701201:500Early surgery: 80.1
Late surgery: 79.56		RetrospectiveQuality of life, complicationsIIINR
Sun et al.
[61]		2024China669179:49072.49Multicenter cross-sectional studyCurrent status of postoperative care for elderly osteoporotic fracture patientIIOsteoporosis treatment for 303 (45.3%) patients
after surgery
Sun et al.
[63]		2024China4010:30ITF: 72.8 
PFNA: 73.7		Retrospective cohortSurgical and rehabilitation data, functional outcome (Harris hip score), quality of life (SF-36), complicationsIIINR
Solberg et al.
[64]		2023Norway516146:37084Prospective cohortComparison of two orthogeriatric care modelsIITreatment with anti-osteoporosis drugs in hospital: 70%
Sniderman et al.
[65]		2023Canada15034:116HA: 83.2
ORIF: 84		Retrospective cohortBlood loss, complicationsIIINR
Song et al. [66]2020China9462:32Control group: 70.6
Delayed group: 73		Prospective cohortFunctional outcome (Harris hip score), quality of lifeIINR
Sundkvist et al.
[67]		2024Sweden291139:15282Multicenter prospective cohortTreatment failure, reoperations, mortality rate at 30 days, 90 days, and 1 yearIINR
Tan et al.
[68]		2017Singapore2029518:151178.8RetrospectiveComplications, ambulatory status at discharge, length of hospital stayIIINR
Takahashi et al.
[74]		2020Japan22856:17285Retrospective cohortPatients’ ambulation ability before injury, at discharge, and 6 months after injury (Functional Ambulation Category), presurgical duration, length of hospital stay, time until beginning to walk using parallel bars, complications affecting treatment, mortality rateIIINR
Tian et al.
[75]
2020China9048:4270.5Prospective cohortFunctional outcome (Harris hip score), complicationsIINR
Tilaveridis et al.
[76]
2023Greece118 82.7Prospective cohortRadiographic outcome, complicationsIINR
Tol et al.
[77]		2017Netherlands25247:20581.1Prospective randomizedFunctional outcome, (modified Harris hip score), postoperative complications, intra-operative dataINR
Uzel et al.
[78]		2024Turkey53,49535.841:17.65486Retrospective registryComplication, mortalityIIINR
Vasu et al.
[79]		2018India6034:26 Prospective cohortAssociation of modified frailty index (MFI) with 90-day mortalityIINR
Vigano et al.
[82]		2023Italy79,12017,040:54,87784Retrospective registryFracture incidence, epidemiology, mortality, costIIINR
Wang et al.
[83]		2023China644174:47081.66Retrospective1-year mortality, major complications, and AKI by BMI categoryIIINR
Wang et al.
[82]		2022China761247:51481.23RetrospectiveLength of hospital stay, postoperative complications, 30-day and one-year mortalities, one-year functional statusIIINR
Wignadasan et al.
[84]		2024UK335105:224Cemented: 84.7
Uncemented: 85.9		RetrospectiveLength of hospital stay, discharge destination, morbidity, mortality, theater time, costIIINR
Xu et al.
[85]		2025China300161:13985.88Prospective cohortFracture reduction, Harris hip score at 1 and 6 months after surgery, failure of internal fixationIINR
Yan et al.
[86]		2024China8023:5780.5RetrospectiveTorn conjoined tendons, dislocation and complication rateIIINR
Yin et al.
[87]		2024China14150:91DAA: 73.98
PLA: 76.72		RetrospectiveHospitalization days, VAS score, Harris hip score at one month and six months, incidence of complications, revision rate, one-year survival rate, patient satisfactionIIINR
Yu et al.
[80]		2016China11767:80PFNA-II: 74.2
IT group: 75.2		ProspectiveIntraoperative variables, postoperative complicationsIINR
Zhou et al.
[91]		2020China224114:11068.52Prospective cohortFunctional outcome (Harris hip score), rates of revision, loosening, periprosthetic fracture, dislocationIINR
Zhou et al.
[92]		2019China10863:4575.3Prospective cohortOperation time, intraoperative bleeding, immobilization duration, hospitalization time, Harris hip score, postoperative complicationsIIBMD testing (DXA), initiation of alendronate and vitamin D3
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Daskalakis, I.I.; Bastian, J.D.; Tosounidis, T.H. Time Is Bone: Missed Opportunities for Secondary Prevention After a Hip Fracture. J. Clin. Med. 2025, 14, 5816. https://doi.org/10.3390/jcm14165816

AMA Style

Daskalakis II, Bastian JD, Tosounidis TH. Time Is Bone: Missed Opportunities for Secondary Prevention After a Hip Fracture. Journal of Clinical Medicine. 2025; 14(16):5816. https://doi.org/10.3390/jcm14165816

Chicago/Turabian Style

Daskalakis, Ioannis I., Johannes D. Bastian, and Theodoros H. Tosounidis. 2025. "Time Is Bone: Missed Opportunities for Secondary Prevention After a Hip Fracture" Journal of Clinical Medicine 14, no. 16: 5816. https://doi.org/10.3390/jcm14165816

APA Style

Daskalakis, I. I., Bastian, J. D., & Tosounidis, T. H. (2025). Time Is Bone: Missed Opportunities for Secondary Prevention After a Hip Fracture. Journal of Clinical Medicine, 14(16), 5816. https://doi.org/10.3390/jcm14165816

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop