Underuse of osteoporosis treatments before and after hip fracture: longitudinal findings from the Gruppo Italiano di Ortogeriatria (GIOG 2.0) study

Background: Osteoporosis is a major cause of fragility fractures, with hip fracture (HF) representing the most severe complication in older adults. However, national data on osteoporosis treatment use before and after hip fracture in Italy are limited. Methods: This multicenter prospective study included individuals aged ≥65 years admitted for HF between July 2019 and June 2024 at 12 orthogeriatric centers. Osteoporosis treatments (vitamin D, calcium, antiresorptive, anabolic, dual effect agents) were recorded at admission, discharge, and 120- and 365-day follow-ups. Patients were classified as "Never users" if untreated throughout the study period or "Ever users" if treated at least once. Multivariate logistic regression identified factors independently associated with lack of treatment. Results: Among 1,012 patients (median age 83 years; 77.2% female), 85.6% were untreated at admission; this proportion dropped to 34.4% at discharge but rose again to 50% at 1 year. Vitamin D and calcium were the predominant treatments, while antiresorptive, anabolic, and dual effect agents were underused. Overall, 22% of patients were classified as "Never users". They were generally older, more often male, and had higher comorbidity, dementia, frailty, and mobility limitations. Only male sex was independently associated with lack of treatment (Odds Ratio 2.37, 95% Confidence Intervals 1.59-3.55). Conclusion: Despite clinical guideline recommendations, osteoporosis treatment remains suboptimal among older HF patients in Italy, especially in male patients. Findings support the need for national programs and multidisciplinary strategies to reduce the treatment gap and improve long-term management.