Patients with periprosthetic femoral fractures are older adults who are commonly diagnosed with osteoporosis

Abstract

This study focused on individuals aged ≥ 50 years with periprosthetic femoral fractures (PFF). When compared to those with native hip fractures, patients with PFF were older, had a higher BMI, and demonstrated a greater number of comorbidities. Given the high frequency of osteoporosis risk factors and the BMD results, PFF should be classified as osteoporotic fractures.

Introduction: To compare patients presenting with periprosthetic femoral fractures (PFF) to patients with native hip fractures with a special focus on bone mineral density (BMD) measurements, in order to reinforce the hypothesis that PFF are osteoporotic fractures.

Methods: A retrospective, single-centre, observational study of all patients aged ≥ 50 years with low-energy PFF identified at the Lille University Hospital from January 1, 2016, to December 31, 2022, was conducted. The PFF group was compared to a group of patients with native hip fractures hospitalized during the same period. To compare the T-score data, we used a linear mixed model that considered a predefined adjustment for age, sex, and BMI. Adjusted means ± standard error of the mean (SEM) are derived from the mixed model.

Results: Among 71 patients with PFF (78.9% female, median (IQR) age 81 (72-88) years), osteoarthritis (57.8%) was the primary indication for hip surgery. Compared with the native hip fracture group (n = 117), patients in the PFF group were significantly older (p = 0.002), had a significantly greater BMI (p = 0.043), and had a higher history of multiple falls (54.3% vs. 26.1%, p < 0.001). A greater frequency of previous low-energy fractures (69.0% vs. 44.0%, p < 0.001) and an increased prescription of anti-osteoporosis medications (26.8% vs. 11.1%, p = 0.006) in patients with PFF were found. Adjusted T-scores differed between the two groups at the lumbar spine (mean adjusted ± SEM, - 0.5 ± 0.2 (PFF group) vs. - 1.2 ± 0.2 (comparator group), p = 0.008) but not at the femoral neck or at the total hip.

Conclusion: Low-energy PFF should be considered as an osteoporotic fracture and treated accordingly.

Keywords: Bone mineral density; Fracture liaison service; Osteoporosis; Periprosthetic femoral fractures; Periprosthetic fractures.

Fig. 1

Flowchart. BMD, bone mineral density; FLS, Fracture Liaison Service; MID, Medical Information Department; PFF, periprosthetic femoral fracture; PPF, periprosthetic fractures