What treatments are used for osteoporosis following a hip fracture?

From the Guidelines

Treatment for osteoporosis after a hip fracture should prioritize bisphosphonates, such as oral alendronate 70 mg once weekly or intravenous zoledronic acid 5 mg annually, as they have been shown to reduce the risk of vertebral, non-vertebral, and hip fractures 1.

Medications

• Bisphosphonates are the first-line treatment, with alendronate and risedronate being preferred due to their efficacy, tolerability, and low cost 1
• For patients with oral intolerance or non-compliance, intravenous zoledronic acid or subcutaneous denosumab are alternative options 1
• Anabolic agents, such as teriparatide, may be considered for high-risk patients with severe osteoporosis 1

Lifestyle Modifications

• Calcium and Vitamin D supplementation should be encouraged, with a daily intake of 1000-1200 mg of calcium and 800-1000 IU of vitamin D 1
• Physical therapy should be initiated as soon as possible after surgery to improve mobility, strength, and balance, reducing the risk of future falls 1
• Fall prevention measures, such as removing tripping hazards and installing grab bars, should be implemented 1
• Weight-bearing exercises, such as walking or tai chi, should be encouraged to stimulate bone formation 1
• Smoking cessation and limiting alcohol intake are also crucial for maintaining bone health 1

Treatment Duration and Monitoring

• Treatment with bisphosphonates is typically prescribed for 3-5 years, with longer durations for patients who remain at high risk 1
• Regular monitoring of tolerance and adherence to treatment is essential, as well as systematic follow-up to assess fracture risk and adjust treatment as needed 1

From the Research

Treatments for Osteoporosis Following a Hip Fracture

• The primary treatment for osteoporosis following a hip fracture includes anti-resorptive therapies, such as bisphosphonates, which have been shown to reduce the risk of fractures, especially at sites primarily composed of cortical bone such as the hip 2.
• Alendronate, a potent anti-resorptive drug, has been found to reduce the risk of hip fractures by 55% in postmenopausal women with osteoporosis 2.
• Other treatments, such as estrogen replacement therapy, calcitonin, calcium, and vitamin D therapy, may also be used to treat osteoporosis following a hip fracture 3.
• Bisphosphonates, such as residronate, have been shown to be effective in reducing the risk of hip fractures and improving functional mobility in patients with osteoporosis 3.
• Selective estrogen-receptor modulators, such as raloxifene, may also be used to treat osteoporosis following a hip fracture 4.

Compliance and Persistence with Treatment

• Compliance with osteoporosis treatment following a hip fracture is often suboptimal, with many patients not receiving recommended treatment 3, 4.
• A study found that only 6% of patients received treatment for osteoporosis following a hip fracture, and among those who received alendronate, the 12-month mean medication possession ratio was 67% 4.
• Interventions, such as resident-focused education and electronic order sets, have been shown to improve rates of timely osteoporosis treatment following fragility hip fracture 5.

Treatment in Men

• Osteoporosis in men is often under-recognized and undertreated, despite contributing to significant morbidity and mortality 6.
• Bisphosphonates have been shown to be effective in reducing the risk of fragility fractures in men with osteoporosis, and may be used as monotherapy or in combination with testosterone replacement therapy 6.