Osteoporosis treatment gap prior to femoral fracture and prevalence of pharmacological risk factors: a prospective observational study.

INTRODUCTION

Hip fractures are a major complication of osteoporosis and are associated with high morbidity, mortality, and costs. Despite clear guideline recommendations, pharmacological osteoporosis treatment remains underutilized. In addition, medications that increase fall and fracture risk further contribute to fracture occurrence. The aim of this study was to assess guideline concordance of osteoporosis therapy and to quantify the prevalence of medications associated with increased fall and fracture risk prior to the fracture in patients admitted with femoral fractures.

MATERIALS AND

METHODS

In this prospective observational study, 145 patients aged ≥ 55 years admitted with femoral neck, per- and subtrochanteric, femoral shaft and distal femur fractures to a tertiary academic trauma center between April and June 2025 were included. Pre-admission medication was assessed using structured medication reconciliation. Guideline concordance of pre-fracture osteoporosis therapy was evaluated according to the current Austrian osteoporosis guideline (Dimai et al., 2024). Fall-risk-increasing drugs (FRIDs) were identified using the STOPPFall criteria, and fracture-associated medications were recorded based on Austrian osteoporosis guideline-defined drug classes.

RESULTS

Among 145 included patients (mean age 80.4 years; 71% female), 117 (81%) met criteria for pharmacological osteoporosis treatment prior to the fracture, defined by a preexisting osteoporosis diagnosis or a 10-year fracture risk above the treatment intervention threshold using the FRAX® calculator. Only 9 (7.7%) of these patients were treated in accordance with guideline recommendations. A treatment gap was observed in 78.6% of therapy-eligible patients. At least one FRID was prescribed in 70% of patients, and 57% received at least one medication associated with increased fracture risk.

CONCLUSIONS

Patients presenting with femoral fractures demonstrate a substantial gap in guideline-concordant osteoporosis therapy and a high prevalence of medications associated with increased fall and fracture risk. These findings highlight important opportunities for systematic primary and secondary fracture prevention and structured medication review.