Abstract
Summary
Osteoporotic fractures, especially fragility hip fractures, are major causes of mortality and morbidity in the elderly. There is a significant gap in the diagnosis and treatment of osteoporosis in patients with fragility fractures. Vitamin D use increased by 18.2% post-admission, while calcium use rose by 21.1%. Additionally, the prescription of bisphosphonates, an osteoclast inhibitor, increased by 1.2% post-admission. The study highlights the urgent need for improved management practices and more proactive care strategies to address osteoporosis and its complications.
Introduction
Osteoporotic fractures are a major cause of fragility hip fractures, and in Saudi Arabia, the high prevalence of osteoporosis and high costs highlight the need for comprehensive care. This study aimed to evaluate the management of osteoporosis in hospitalized patients with fragility hip fractures in western Saudi Arabia.
Methods
This retrospective cohort study examined medical records from individuals with fragility hip fractures at King Abdulaziz Medical City in Saudi Arabia, Jeddah, from 2004 to 2024. Data was collected from electronic health records, including demographics, clinical features, comorbidities, fall history, osteoporosis diagnosis, and medication usage.
Results
The study included 314 patients, with a mean age of 73 years and 31.2% being between 71 and 80 years old. The majority were females, with a mean BMI of 26.6 kg/m2. The most common comorbidity was renal failure. The prevalence of pre-admission diagnosis of osteoporosis was 14%. Post-admission DEXA-BMD use was reported by 16.6%. Vitamin D (41.1%) and calcium (42.4%) were higher in post-admission management compared to pre-admission management.
Conclusion
The study found that most hospitalized patients with fragility hip fractures were female, overweight, had a history of falls, and suffered from renal failure. This study opens new areas for future research that could increase our understanding of osteoporosis management.
Similar content being viewed by others
Data Availability
Primary data available upon reasonable request.
References
Bukata SV, Digiovanni BF, Friedman SM et al (2011) A guide to improving the care of patients with fragility fractures. Geriatr Orthop Surg Rehabil 2:5–37. https://doi.org/10.1177/2151458510397504
Bentler SE, Liu L, Obrizan M et al (2009) The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 170:1290–1299. https://doi.org/10.1093/aje/kwp266
Lee GE, Muffly S, Golladay GJ (2019) Management of fragility hip fractures: our institutional experience. Geriatr Orthop Surg Rehabil 10:2151459319828618. https://doi.org/10.1177/2151459319828618
Ip TP, Leung J, Kung AWC (2010) Management of osteoporosis in patients hospitalized for hip fractures. Osteoporos Int 21:S605-614. https://doi.org/10.1007/s00198-010-1398-8
Hodsman AB, Leslie WD, Tsang JF, Gamble GD (2008) 10-year probability of recurrent fractures following wrist and other osteoporotic fractures in a large clinical cohort: an analysis from the Manitoba Bone Density Program. Arch Intern Med 168:2261. https://doi.org/10.1001/archinte.168.20.2261
Satomi E (2009) Sitta M do C, Machado AN, Garcez Leme LE: Identification and treatment of osteoporosis among elderly patients with hip fractures. Clinics (Sao Paulo) 64:1201–1204. https://doi.org/10.1590/S1807-59322009001200010
Panneman MJM, Lips P, Sen SS, Herings RMC (2004) Undertreatment with anti-osteoporotic drugs after hospitalization for fracture. Osteoporos Int 15:120–124. https://doi.org/10.1007/s00198-003-1544-7
Tai T-W, Li C-C, Huang C-F, Chan WP, Wu C-H (2022) Treatment of osteoporosis after hip fracture is associated with lower all-cause mortality: a nationwide population study. Bone 154:116216. https://doi.org/10.1016/j.bone.2021.116216
Rabenda V, Vanoverloop J, Fabri V et al (2008) Low incidence of anti-osteoporosis treatment after hip fracture. J Bone Joint Surg-Am Vol 90:2142–2148. https://doi.org/10.2106/JBJS.G.00864
Beaupre LA, Majumdar SR, Dieleman S, Au A, Morrish DW (2012) Diagnosis and treatment of osteoporosis before and after admission to long-term care institutions. Osteoporos Int 23:573–580. https://doi.org/10.1007/s00198-011-1582-5
Kung AW, Fan T, Xu L et al (2013) Factors influencing diagnosis and treatment of osteoporosis after a fragility fracture among postmenopausal women in Asian countries: a retrospective study. BMC Women’s Health 13:7. https://doi.org/10.1186/1472-6874-13-7
El-Desouki MI (2003) Osteoporosis in postmenopausal Saudi women using dual x-ray bone densitometry. Saudi Med J 24:953–956
Sadat-Ali M, Al-Habdan IM, Al-Turki HA, Azam MQ (2012) An epidemiological analysis of the incidence of osteoporosis and osteoporosis-related fractures among the Saudi Arabian population. Ann Saudi Med 32:637–641. https://doi.org/10.5144/0256-4947.2012.637
Amin TT, Al Owaifeer A, Al-Hashim H, AlWosaifer A, Alabdulqader M, Al Hulaibi F, Al Hamam A (2013) Osteoporosis among older Saudis: risk of fractures and unmet needs. Arch Osteoporos 8:118. https://doi.org/10.1007/s11657-013-0118-3
Bubshait D, Sadat-Ali M (2007) Economic implications of osteoporosis-related femoral fractures in Saudi Arabian Society. Calcif Tissue Int 81:455–458. https://doi.org/10.1007/s00223-007-9090-5
Sadat-Ali M, Al-Omran A, Al-Bakr W, Azam MQ, Tantawy A, Al-Othman A (2014) Established osteoporosis and gaps in the management: review from a teaching hospital. Ann Med Health Sci Res 4:198–201. https://doi.org/10.4103/2141-9248.129038
Al Saleh Y, El Seid ME, Ruhaiyem ME et al (2020) Characteristics and outcomes of osteoporotic hip fractures: treatment gaps in a tertiary care center in Riyadh. Saudi Arabia Aging Clin Exp Res 32:1689–1695. https://doi.org/10.1007/s40520-019-01377-2
Imran M, Singh A, Bhardwaj A, Agrawal D (2022) Prevalence of osteoporosis and associated risk factors among postmenopausal women: a cross-sectional study from northern India. J Midlife Health 13:206–212. https://doi.org/10.4103/jmh.jmh_114_22
Puth M-T, Klaschik M, Schmid M, Weckbecker K, Münster E (2018) Prevalence and comorbidity of osteoporosis– a cross-sectional analysis on 10,660 adults aged 50 years and older in Germany. BMC Musculoskelet Disord 19:144. https://doi.org/10.1186/s12891-018-2060-4
Sözen T, Özışık L, Başaran NÇ (2017) An overview and management of osteoporosis. Eur J Rheumatol 4:46–56. https://doi.org/10.5152/eurjrheum.2016.048
Samson Enitan S, Ngozi Adejumo E, Osaigbovoh Imaralu J, Ademola Adelakun A, Anike Ladipo O, Bosede Enitan C (2023) Personalized medicine approach to osteoporosis management in women: integrating genetics, pharmacogenomics, and precision treatments. Clin Res Commun. 6:18. https://doi.org/10.53388/CRC2023018
Asadipooya K, Abdalbary M, Ahmad Y, Kakani E, Monier-Faugere M-C, El-Husseini A (2021) Bone quality in chronic kidney disease patients: current concepts and future directions - part II. Kidney Dis (Basel) 7:359–371. https://doi.org/10.1159/000515542
Huang J-F, Zheng X-Q, Sun X-L et al (2020) Association between bone mineral density and severity of chronic kidney disease. Int J Endocrinol 2020:1–11. https://doi.org/10.1155/2020/8852690
Resnick B, Nahm ES, Zhu S, Brown C, An M, Park B, Brown J (2014) The impact of osteoporosis, falls, fear of falling, and efficacy expectations on exercise among community-dwelling older adults. Orthop Nurs 33:277–86; quiz 287–8. https://doi.org/10.1097/NOR.0000000000000084
Morrison A, Fan T, Sen SS, Weisenfluh L (2013) Epidemiology of falls and osteoporotic fractures: a systematic review. Clinicoecon Outcomes Res 5:9–18. https://doi.org/10.2147/CEOR.S38721
Afrin N, Sund R, Honkanen R, Koivumaa-Honkanen H, Rikkonen T, Williams L, Kröger H (2020) A fall in the previous 12 months predicts fracture in the subsequent 5 years in postmenopausal women. Osteoporos Int 31:839–847. https://doi.org/10.1007/s00198-019-05255-5
Han A, Park Y, Lee Y-K, Park SY, Park CY (2022) Position statement: vitamin D intake to prevent osteoporosis and fracture in adults. J Bone Metab. 29:205–15. https://doi.org/10.11005/jbm.2022.29.4.205
Lewiecki EM (2000) Osteoporosis: Clinical Evaluation. In: Feingold KR, Anawalt B, Blackman MR, et al. (eds) Endotext. MDText.com, Inc, South Dartmouth (MA)
Bodenner D, Redman C, Riggs A (2007) Teriparatide in the management of osteoporosis. Clin Interv Aging 2:499–507. https://doi.org/10.2147/cia.s241
Roy AN, Mazumdar I (2023) Effects of teriparatide treatment on bone mineral density in patients with osteoporosis: a short-term dose-response study. Cureus 15:e45662. https://doi.org/10.7759/cureus.45662
Acknowledgements
The authors gratefully acknowledge Content Concepts (www.contentconcepts.com) for the English language editing.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Fayez S. Alharthy, Saeed S. Majadah, Salwa B. Alaidarous, and Eman A. Alsindi. The first draft of the manuscript was written by Sahar S. Alahmadi, Renad F. Alharthy, and Abdullah Almalki. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflicts of interest
None.
Disclaimer
The views expressed in the submitted article are not an official position of the institution and only the authors’ opinion.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Alharthy, F.S., Almalki, A., Alsindi, E.A. et al. The management of osteoporosis in hospitalized patients with fragility hip fractures in western Saudi Arabia: a real-world tertiary center experience. Arch Osteoporos 20, 29 (2025). https://doi.org/10.1007/s11657-025-01511-w
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s11657-025-01511-w