The study found that patients who began treatment soon after their initial fracture cut their risk of PPFs by half and also lowered the likelihood of sustaining a second hip fracture on the opposite side. Despite similar long-term mortality rates compared to other fracture types, individuals with PPFs faced a higher burden of subsequent major osteoporotic fractures, underscoring the importance of preventive therapy.
The study was led by Dr. Shau-Huai Fu and colleagues from the Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan. Using data from Taiwan’s National Health Insurance Research Database, the researchers analyzed outcomes for more than 48,000 patients who sustained hip fractures between 2016 and 2018. They aimed to assess the incidence, risk factors, and prognosis of PPFs and evaluate whether initiating AOM could mitigate these risks.
“Periprosthetic fractures remain a serious complication after hip fracture, with significant consequences for patient health,” the authors explained. “Our findings highlight the protective role of osteoporosis treatment in reducing both periprosthetic and contralateral second hip fractures.”
The key findings of the study were as follows:
- Out of the total cohort, 443 patients (0.9%) developed periprosthetic fractures (PPFs).
- A total of 2,285 patients (4.8%) experienced contralateral second hip fractures (2HFs).
- Patients aged 60 to 69 were at particularly high risk for PPFs.
- Initiating anti-osteoporotic medication (AOM) after the first hip fracture reduced the risk of PPFs (HR 0.50).
- AOM initiation also lowered the risk of contralateral second hip fractures (HR 0.85).
- Five-year mortality rates were similar between PPF and 2HF patients (33% vs. 30%).
- Patients with PPFs were twice as likely to experience subsequent major osteoporotic fractures compared with 2HF patients (7.5% vs. 3.7%).
- PPFs are associated with a higher risk of long-term disability and reduced quality of life, beyond mortality.
The authors concluded that early initiation of osteoporosis therapy after hip fracture represents an important preventive strategy. By reducing the risk of both PPFs and second hip fractures, AOM use has the potential to improve long-term outcomes for older adults recovering from hip fractures. They noted that further research is needed to optimize treatment protocols and encourage broader adoption of AOM use in clinical practice.
"The study adds to the growing body of evidence supporting proactive management of osteoporosis in patients with hip fractures. Given the high rates of complications and the burden on healthcare systems, ensuring that more patients receive appropriate treatment could play a critical role in improving outcomes and preventing future fractures," the authors concluded.
Reference:
Lo, SW., Yen, HK., Huang, CC. et al. Incidence, risk factors, prognosis of periprosthetic fractures post hip fracture: unveiling protective role of anti-osteoporotic medication. Osteoporos Int (2025). https://doi.org/10.1007/s00198-025-07670-3
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