Skip to main content

Effects of postoperative osteoporosis treatment on subsequent fracture and the 5-year survival rates after hemiarthroplasty for hip fracture



According to the literature, only 20–30% of patients are screened for osteoporosis after a hip fracture. Osteoporosis treatment may have a potential protective effect on the 5-year mortality rate. Our results demonstrated that 5-year survival is higher in patients who received osteoporosis treatment after hemiarthroplasty for hip fracture compared with those who did not.


This study aims to investigate the status of osteoporosis treatment in patients who underwent hemiarthroplasty for an osteoporotic hip fracture and to compare subsequent fractures and the 5-year survival rates of these patients with those who did not receive the osteoporosis treatment.


Patients > 65 years of age who underwent hemiarthroplasty for an osteoporotic hip fracture were included in this retrospective multicenter study. Patients who died within 12 months postoperative, who were lost to follow-up, and those with malignancy and secondary osteoporosis were excluded. Group I comprised patients who had no postoperative osteoporosis screening and treatment, and Group II comprised those who received the screening and treatment.


A total of 460 of 562 patients (82%) did not receive osteoporosis treatment after hip fracture. No significant difference was observed between the groups in terms of subsequent fracture numbers and fracture sites (p = 0.296 and 0.240, respectively). Mean 5-year survival rate was significantly higher in Group II (p = 0.002).


According to our results, elderly patients who underwent hemiarthroplasty for an osteoporotic hip fracture were not commonly screened or treated for osteoporosis. Our results demonstrated no significant difference between the groups in terms of subsequent fracture. However, we observed a significant high 5-year survival rate among patients who received the osteoporosis treatment.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA (2000) Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int 11(5):460–466

    CAS  Article  Google Scholar 

  2. 2.

    Tosteson AN, Gabriel SE, Grove MR, Moncur MM, Kneeland TS, Melton LJ 3rd (2001) Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int 12(12):1042–1049

    CAS  Article  Google Scholar 

  3. 3.

    Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20(10):1633–1650.

    CAS  Article  Google Scholar 

  4. 4.

    Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152(6):380–390.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Hallberg I, Bachrach-Lindström M, Hammerby S, Toss G, Ek AC (2009) Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study. BMC Musculoskelet Disord 10:135.

  6. 6.

    Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025, 2007. J Bone Miner Res 22(3):465–475.

  7. 7.

    Pike C, Birnbaum HG, Schiller M, Swallow E, Burge RT, Edgell ET (2011) Economic burden of privately insured non-vertebral fracture patients with osteoporosis over a 2-year period in the US. Osteoporos Int 22(1):47–56.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Shi N, Foley K, Lenhart G, Badamgarav E (2009) Direct healthcare costs of hip, vertebral, and non-hip, non-vertebral fractures. Bone 45(6):1084–1090.

    Article  PubMed  Google Scholar 

  9. 9.

    Johnell O, Kanis JA, Jonsson B, Oden A, Johansson H, De Laet C (2005) The burden of hospitalised fractures in Sweden. Osteoporos Int 16(2):222–228.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jönsson B (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15(3):175–179.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297(4):387–394.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    von Friesendorff M, McGuigan FE, Besjakov J, Akesson K (2011) Hip fracture in men-survival and subsequent fractures: a cohort study with 22-year follow-up. J Am Geriatr Soc 59(5):806–813.

    Article  Google Scholar 

  13. 13.

    Mugnier B, Daumas A, Couderc AL, Mizzi B, González T, Amrani A, Lévêque P, Aymes B, Argenson JN, Villani P (2018) Clinical effectiveness of osteoporosis treatment in older patients: a fracture liaison service-based prospective study. J Women Aging 8:1–13.

    Article  Google Scholar 

  14. 14.

    Nurmi-Lüthje I, Sund R, Juntunen M, Lüthje P (2011) Post-hip fracture use of prescribed calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs is associated with lower mortality: a nationwide study in Finland. J Bone Miner Res 26(8):1845–1853.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Beaupre LA, Morrish DW, Hanley DA, Maksymowych WP, Bell NR, Juby AG, Majumdar SR (2011) Oral bisphosphonates are associated with reduced mortality after hip fracture. Osteoporos Int 22(3):983–991.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Jha S, Wang Z, Laucis N, Bhattacharyya T (2015) Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996-2012: an ecological analysis. J Bone Miner Res 30(12):2179–2187.

    CAS  Article  Google Scholar 

  17. 17.

    Friedman SM, Mendelson DA, Kates SL, McCann RM (2008) Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc 56(7):1349–1356.

    Article  PubMed  Google Scholar 

  18. 18.

    Bukata SV, Digiovanni BF, Friedman SM, Hoyen H, Kates A, Kates SL, Mears SC, Mendelson DA, Serna FH Jr, Sieber FE, Tyler WK (2011) A guide to improving the care of patients with fragility fractures. Geriatr Orthop Surg Rehabil 2(1):5–37.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD (2014) Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res 29(9):1929–1937.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Kim SC, Kim MS, Sanfélix-Gimeno G, Song HJ, Liu J, Hurtado I, Peiró S, Lee J, Choi NK, Park BJ, Avorn J (2015) Use of osteoporosis medications after hospitalization for hip fracture: a cross-national study. Am J Med 128(5):519–526.e1.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Desai RJ, Mahesri M, Abdia Y, Barberio J, Tong A, Zhang D, Mavros P, Kim SC, Franklin JM (2018) Association of osteoporosis medication use after hip fracture with prevention of subsequent nonvertebral fractures: an instrumental variable analysis. JAMA Netw Open 1(3):e180826.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Degli Esposti L, Girardi A, Saragoni S, Sella S, Andretta M, Rossini M, Giannini S; on the behalf of the Study group (2018) Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk. Endocrine, 64, 367, 377

  23. 23.

    Brozek W, Reichardt B, Zwerina J, Dimai HP, Klaushofer K, Zwettler E (2016) Antiresorptive therapy and risk of mortality and refracture in osteoporosis-related hip fracture: a nationwide study. Osteoporos Int 27(1):387–396.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39(2):203–209.

    Article  PubMed  Google Scholar 

  25. 25.

    Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353(9156):878–882.

    Article  PubMed  Google Scholar 

  26. 26.

    Kassam AA, Griffiths S, Higgins G (2014) Historical implant or current best standard? Minimum five year follow-up outcomes of cemented Thompson hemiarthroplasties. J Arthroplast 29(9):1745–1748.

    Article  Google Scholar 

  27. 27.

    Su FM, Chen YC, Cheng TT, Lin WC, Lui CC (2015) Is raloxifene associated with lower risk of mortality in postmenopausal women with vertebral fractures after vertebroplasty?: a hospital-based analysis. BMC Musculoskelet Disord 16:209–205.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Bolland MJ, Grey AB, Gamble GD, Reid IR (2010) Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab 95(3):1174–1181.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    van Geel TACM, Bliuc D, Geusens PPM, Center JR, Dinant GJ, Tran T, van den Bergh JPW, McLellan AR, Eisman JA (2018) Reduced mortality and subsequent fracture risk associated with oral bisphosphonate recommendation in a fracture liaison service setting: a prospective cohort study. PLoS One 13(6):e0198006.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Lyles KW, Colón-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L, Moore KA, Lavecchia C, Zhang J, Mesenbrink P, Hodgson PK, Abrams K, Orloff JJ, Horowitz Z, Eriksen EF, Boonen S, HORIZON Recurrent Fracture Trial (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357(18):1799–1809.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Yalkin Camurcu.

Ethics declarations

This retrospective multicenter study was performed with the approval of an institutional ethical review board and in accordance with the Declaration of Helsinki.

Conflict of interest


Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cobden, A., Cobden, S.B., Camurcu, Y. et al. Effects of postoperative osteoporosis treatment on subsequent fracture and the 5-year survival rates after hemiarthroplasty for hip fracture. Arch Osteoporos 14, 100 (2019).

Download citation


  • Osteoporosis
  • Hip fracture
  • Hemiarthroplasty
  • Mortality
  • Survival