Medical and social consequences of osteoporotic proximal femoral fracture in residents of Yekaterinburg

BACKGROUND: The most severe complication of osteoporosis is a fracture of the proximal femur. High mortality, disability, and economic costs determine the significance of fractures at this site for healthcare. Repeat fractures following a proximal femoral fracture, associated with low levels of osteoporosis diagnosis and treatment, play a significant role in adverse outcomes.

AIM: To assess the medical and social consequences of osteoporotic proximal femoral fractures and the frequency of secondary fractures, as well as the rate of osteoporosis detection and treatment in individuals at high risk of fractures, in order to inform subsequent changes in healthcare delivery approaches for this patient category.

METHODS: A retrospective cohort study was conducted of patients aged 50 years and older, hospitalized at the Traumatology Department of Yekaterinburg Central City Clinical Hospital No. 23 during 2021 with a diagnosis of “proximal femoral fracture.” The study was performed in two stages. The first stage involved assessing surgical activity and in-hospital mortality in patients with osteoporotic proximal femoral fractures over a 12-month period. The second stage consisted of assessing the medical and social consequences, the detection and treatment of osteoporosis, and the frequency of repeat osteoporotic fractures one year after the proximal femoral fracture.

RESULTS: The study included 514 patients with osteoporotic proximal femoral fractures. Of these, 72 (14%) individuals were transferred to hospitals repurposed for the treatment of the novel coronavirus infection. Surgical treatment was performed on 396 (89.6%) patients: arthroplasty — 157 (39.6%), osteosynthesis — 239 (60.4%). One year after the proximal femoral fracture, 351 (75.3%) were alive, and 115 (24.7%) had died. Medical and social consequences of the proximal femoral fracture were known for 178 individuals. Of these, 5.6% of patients remained immobilized, 53.4% had their activity limited to their apartment, and 41% had resumed an active lifestyle. Repeat fractures within one year occurred in 15.7% of patients. Only 10 (5.6%) individuals were taking anti-osteoporotic medication.

CONCLUSION: The assessment of medical care for osteoporotic proximal femoral fractures showed satisfactory surgical activity, which led to a reduction in mortality after fractures at this site, but also revealed delayed timing of surgical treatment. Insufficient attention to osteoporosis as a cause of fractures and the rare prescription of anti-osteoporotic drugs were identified, indicating the necessity of implementing a system for the prevention of repeat fractures.