Systematic Review of Secondary Prevention Interventions and Approaches for Osteoporosis Management in Older People With Hip Fracture

OBJECTIVE: This review synthesises evidence on pharmacological interventions for secondary osteoporosis in older patients with hip fractures. METHODS: A systematic review of five databases-Embase, Medline ALL, Cochrane Library, Web of Science Core Collection and Web of Science Preprint Citation Index-for articles published between January 2010 and July 2024. Abstracts and full texts were screened independently by multiple reviewers and critically appraised. Health outcomes, including refractures, follow-up bone mineral density (BMD) scans and treatment adherence, were synthesised, and adverse effects were examined in relation to study characteristics. RESULTS: A total of 60 articles met the inclusion criteria, and 40% were retrospective cohort studies. The median sample size within the included studies was 775 patients, with a median age of 78.7 years. Bisphosphonates (87%), anabolic agents (52%) and other antiresorptive agents (47%) were common pharmacological interventions. The average follow-up duration was 12 months. The cumulative refracture rate over 12 months was 3%, with a median incidence rate of 8%. Among patients who did not receive pharmacological treatment, the average refracture rate was 10%, compared with 4% in those who did receive treatment. Only 13 studies (22%) reported follow-up BMD. The implementation of fracture liaison services (FLS) was associated with an average of 44% increase in treatment initiation rates across four studies. CONCLUSION: Pharmacological treatment reduces refracture rates in older adults with hip fractures, especially when initiated through FLS. Although bisphosphonates are most commonly studied, anabolic and other antiresorptive agents also show benefits. Improved reporting on BMD follow-up and adherence is needed to guide long-term osteoporosis management.