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. 2025 Aug;36(8):1405-1415.
doi: 10.1007/s00198-025-07564-4. Epub 2025 Jul 12.

Contemporary pharmacological management of patients after hip fracture: a population-based cohort of over 120,000 patients in Spain

Fran Llopis-Cardona  1 , Clara L Rodríguez-Bernal  2   3 , Isabel Hurtado  1   4 , Mireia Espallargues  4   5 , Nekane García  6 , Iñigo Gorostiza  4   7   8 , Javier Gorricho  6 , Julián Librero  4   9 , Eduardo Millán  4   10 , Gracia Modroño  11 , Naiara Parraza  4   12 , Gabriel Sanfélix-Gimeno  1   4
Affiliations

Contemporary pharmacological management of patients after hip fracture: a population-based cohort of over 120,000 patients in Spain

Fran Llopis-Cardona et al. Osteoporos Int. 2025 Aug.

Abstract

Treatment with antiosteoporotics is recommended after a hip fracture to reduce the risk of a new fracture or death. In our study, we found a slight increase in treatment rates over time, but an important treatment gap in the contemporary secondary prevention of hip fracture is still present.

Introduction: The pharmacological management of patients after hip fracture is likely to have changed due to the availability of denosumab during the last decade, but the extent of its use and potential improvement in treatment rates in routine clinical practice is largely unknown.

Methods: We constructed a population-based retrospective cohort of all patients aged 65 years + , discharged alive following hip fracture hospitalization (Jan 2008 to Dec 2021) in several regions of Spain, accounting for one third of the country's population. The proportion of patients prescribed any antiosteoporotic (AO) medication and specific classes in the first 90 days after discharge was evaluated. Temporal trends of treatment prescription per month were plotted. All analyses were performed also by age, sex, and region.

Results: In a cohort of over 120,000 patients, we found an important treatment gap in the secondary prevention of hip fracture (78% of patients untreated). Bisphosphonates and denosumab accounted for 60% and 20% of the AO prescriptions, respectively. Treatment gaps were most pronounced among patients aged 85 and over, and males: 26% of patients aged ≤ 84 were treated, in contrast to 18% of those aged 85 + . The proportion of females treated nearly doubled that of males (24% vs 14%). Differences by region were observed. Regarding time trends, despite finding an increase over time, prescription rates remained highly suboptimal. By drug class, treatment with bisphosphonates dropped, whereas denosumab treatment rose along the study period. Concerning management by sex, the Mediterranean regions showed a persistent gap over time, whereas in the Northern regions, the gap was gradually reduced. Treatment patterns by age groups were consistent over time.

Conclusions: Our study offers evidence to identify current gaps of care in secondary prevention of hip fracture and implement adequate strategies to reduce recurrent fractures in this frail population.

Keywords: Bisphosphonates; Denosumab; Drug use; Health service research; Hip fracture; Osteoporosis.

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Conflict of interest statement

Declarations. Conflicts of interest: None.

Figures

Fig. 1
Fig. 1
Proportion of treated patients by age in the secondary prevention of hip fracture in Spain
Fig. 2
Fig. 2
Time trends of secondary prevention of hip fracture in Spain. Proportion of patients with a prescription within 90 days after index date by region
Fig. 3
Fig. 3
Time trends of secondary prevention of hip fracture by drug class and for each sub-cohort among treated
See this image and copyright information in PMC

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