Distal Radial Fracture as an Early Marker of Bone Fragility: A Population-Based Study in Japan.

Fragility fracture site is associated with frailty in older adults: a population-based cohort study in Japan.

Association between fall location and postoperative clinical outcomes after fragility hip fracture: a multicentre cohort study

Abstract Background Fall location may serve as a marker of underlying vulnerability in adults with fragility hip fractures; however, its association with postoperative outcomes remains unclear. This study investigated this association using multicentre prospective registry data. Materials and Methods This retrospective multicentre cohort study analysed Korean Hip Fracture Registry data, including patients aged ≥50 years with proximal femoral fractures treated between June 2016 and December 2024. Fall location was classified as indoor or outdoor. Primary outcomes were functional dependence, gait impairment, and mortality, whereas secondary outcomes included postoperative complications and discharge destination. Logistic regression analysed functional dependence, gait impairment, complications, and discharge destination, whereas Cox proportional hazard regression analysed mortality. Adjusted odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated; sequential adjustment analyses assessed potential confounding. Results Among 5,391 patients with fragility hip fractures, 3,480 (64.6%) sustained indoor falls and 1,911 (35.4%) sustained outdoor falls. Mean follow-up was approximately six months, and most indoor falls occurred at home (80.8%). Compared with outdoor fallers, indoor fallers were older, more often female, had poorer pre-fracture function, and greater comorbidity burden (all p < 0.001). Indoor falls were independently associated with higher risks of functional dependence (adjusted OR 1.19, 95% CI 1.01–1.40, p = 0.043), gait impairment (adjusted OR 1.34, 95% CI 1.18–1.52, p < 0.001), and mortality (adjusted HR 2.27, 95% CI 1.45–3.54, p < 0.001). Discharge destination and postoperative complications were not significantly associated with fall location after full adjustment. Associations were attenuated after adjustment for demographic and clinical factors, but those for functional dependence, gait impairment, and mortality remained significant. Conclusion Patients sustaining indoor falls represent a vulnerable subgroup with poorer functional recovery and higher mortality after fragility hip fractures. Fall location may serve as an additional marker of frailty and postoperative risk, contributing to risk stratification following hip fracture.

Relationship Between Bone Density and Loss of Reduction in Distal Radius Fractures Treated With Volar Locking Plate in Patients Older Than 65 Years.

BACKGROUND Distal radius fractures (DRFs) are common fragility fractures and may be indicators of osteoporosis. The management of these fractures in older people is controversial, with osteoporosis identified as a potential cause of DRF instability. A correlation has been observed between the second metacarpal cortical percentage (2MCP) and bone density, which is essential for understanding postoperative reduction loss. This study aimed to evaluate the relationship between osteoporosis, measured by 2MCP, and loss of reduction in patients older than 65 years with DRFs treated using a volar locking plate (VLP). The secondary aim was to assess factors related to reduction loss. METHODS A retrospective analytical cohort study included patients older than 65 years with DRFs treated with VLP between 2017 and 2023. Baseline characteristics and fracture patterns were recorded. Bone density was assessed using 2MCP from preoperative wrist radiographs. Instability was defined by Lafontaine criteria. Radiological parameters (radial inclination, volar tilt, radial height, and ulnar variance) were measured immediately postoperatively and at follow-up (≥12 weeks). Screw lengths and distances between locking screws and the subchondral articular surface were also evaluated. Patients were divided into 2 groups: osteoporosis (2MCP <50%) and non-osteoporosis (2MCP ≥50%). Comparative and logistic regression analyses were performed. RESULTS A total of 315 patients were included, with 256 in the <50% 2MCP group and 59 in the >50% 2MCP group. Patients in the <50% group were older compared with those in the >50% 2MTC group (74.8 vs 72 years). Statistically significant changes were noted in radiographic parameters, but no significant differences were found between groups. Logistic regression revealed associations between screw positioning, fracture severity, and reduction loss. CONCLUSIONS This study found no association between 2MCP and loss of reduction in DRFs treated with VLP. Screw positioning and fracture severity were more significant factors than bone density in influencing postoperative reduction loss.

Impact of Osteoporosis Therapy in Geriatric Proximal Femur Fractures: A Retrospective Analysis from the German Registry for Geriatric Trauma (ATR-DGU®)

Background: Each year, hundreds of thousands of geriatric patients suffer proximal femur fractures, which often result in irreversible functional decline. Although anti-osteoporotic medications have been shown to reduce the incidence of fragility fractures, the effects of pharmacotherapy on fracture injury patterns, postoperative ambulatory capacity, and survival outcomes are not yet fully understood. Methods: We conducted a retrospective cohort study using the AltersTraumaRegister DGU ® (ATR-DGU), a multicenter prospective registry spanning 196 certified geriatric trauma centers in Germany, Austria, and Switzerland (2016 through 2024). We included patients aged 70 years or older with isolated, surgically treated proximal femur fractures and stratified them by documented use of osteoporosis medication before the index fracture (OM group) versus no pre-fracture therapy (no-OM group). Primary endpoints were mortality during the acute hospital stay and at 120-day follow-up, as well as walking ability—defined as any functional ambulation versus none—at 7 and 120 days postoperatively. The main secondary endpoint was fracture morphology. We fitted multivariable logistic and linear regression models adjusted for age, sex, ASA classification, and anticoagulation; walking-ability models were additionally adjusted for pre-fracture ambulatory status. Results: Of 70,386 patients (mean age, 84.4 years; 70.4% female), 15,771 (22.4%) were receiving osteoporosis medication prior to the index fracture. Patients in the OM group were frailer with worse ASA Scores (80.3% vs. 72.5% with an ASA ≥3) and lower ambulation (62.5% vs. 50.4% requiring at least two crutches or not able to ambulate out of the home environment). Patients in the OM group had a 19% higher chance of sustaining a trochanteric versus a femoral neck fracture than patients in the no-OM group (51.9% vs. 46.8%; adjusted odds ratio 1.19; 95% CI, 1.15 to 1.24; p < 0.001). Pre-existing therapy showed no association with mortality during the acute hospital stay (adjusted OR, 0.93; 95% CI, 0.86 to 1.01; p = 0.098) or with walking ability at 7 days (adjusted OR, 1.03; 95% CI, 0.98 to 1.09; p = 0.198). At the 120-day follow-up (n = 19,544 in the adjusted model follow-up cohort), slightly higher odds of death were observed in the frailer OM group (adjusted OR, 1.12; 95% CI, 1.01 to 1.25; p = 0.04), though the lower confidence bound approached unity. A trend toward improved ambulation was seen in the OM group at 120-day follow-up (adjusted OR, 1.11; 95% CI, 0.99 to 1.25; p = 0.074). Conclusions: Pre-existing osteoporosis therapy was associated with lower odds of femoral neck versus trochanteric fracture patterns. A trend toward improved ambulation accompanied a slightly increased risk of mortality in patients with pre-existing osteoporosis therapy at 120-day follow-up, although this must be weighed against substantial loss to follow-up and residual confounding. More research is needed to understand the effects of anti-osteoporosis medications on patients who do suffer hip fractures despite osteoporotic therapy.

The Impact of Prior Fragility Fractures on Postoperative Outcomes in Anterior Cervical Discectomy and Fusion.

STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate the impact of prior fragility fractures on complications following anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Fragility fractures indicate poor bone quality and increased comorbidities, potentially elevating surgical risks. Understanding the risks is critical for optimizing outcomes in ACDF patients. METHODS Patients undergoing a primary ACDF within 3 years of a fragility fracture were identified from 2013 to 2022. A control cohort without prior fragility fractures was matched 1:1. Exclusion criteria included traumatic fractures, prior revision ACDFs, and active spine infections. Outcomes assessed included 90-day medical and surgical complications, 30-day and 90-day emergency visits and readmission rates, and 2-year complications, including mortality. Statistical analyses included the Pearson χ² test, the Welch t test, and the multivariate logistic regression. RESULTS A total of 1236 patients were matched in each cohort. Prior fragility fractures were associated with higher risks of medical complications, such as atelectasis (4.4% vs. 1.7%, OR: 2.83, P<0.001), respiratory failure (5.0% vs. 2.3%, OR: 2.36, P<0.001), pleural effusion (3.6% vs. 0.9%, OR: 4.35, P<0.001), and urinary tract infections (9.3% vs. 4.5%, OR: 2.20, P<0.001). Surgical complications were also more frequent, including dysphagia (7.0% vs. 4.0%, OR: 1.81, P=0.001), spinal cord deficit (5.0% vs. 2.1%, OR: 27.46, P<0.001), and deep wound infection (1.2% vs. 0.4%, OR: 3.07, P<0.031). Subsequent fragility fractures at 2 years were significantly higher in patients who had a history of fragility fracture (29.0% vs. 4.4%, OR: 10.18, P<0.001), as were 30-day (12.5% vs. 7.3%, OR: 1.87, P<0.001) and 90-day (16.8% vs. 10.3%, OR: 1.82, P<0.001) readmission rates. CONCLUSIONS Patients with a history of fragility fractures undergoing ACDF experience significantly higher rates of postoperative complications and readmission rates.

Concomitant Polytrauma in Fall-Related Proximal Humerus Fractures: A Fracture-Subtype-Stratified Analysis of In-Hospital Outcomes

Objectives: To determine whether concomitant polytrauma is independently associated with worse in-hospital outcomes among fall-related proximal humerus fracture (PHF) patients and whether fracture subtype is associated with heterogeneity in this association. Methods: Retrospective cohort study using the American College of Surgeons Trauma Quality Program Participant Use File (ACS TQP-PUF; 2019–2022). Adults with PHF and a fall mechanism were included. Multivariable logistic regression adjusted for age, sex, the five mFI-5 components, anticoagulant use, and calendar year. Non-home discharge (NHD) was restricted to survivors. Sensitivity analyses used 1:1 PSM (all primary covariates in propensity model; post-matching SMDs assessed) and restriction to ground-level falls. Results: Among 63,995 fall-related PHF patients (70.5% female; 75.8% aged ≥65 years), 3884 (6.1%) met polytrauma criteria (ISS ≥ 16); polytrauma patients were more often male (45.1% vs. 28.5%) and slightly younger (mean age 69.3 vs. 72.0 years). Polytrauma was independently associated with in-hospital mortality (aOR 7.05, 95% CI 6.14–8.09) and non-home discharge among survivors (aOR 1.95, 95% CI 1.79–2.12; crude 72.0% vs. 64.6%). ICU utilization (aOR 13.25, 95% CI 12.34–14.22) and any complication (aOR 3.41, 95% CI 3.07–3.79) are reported as descriptive markers subject to triage and ascertainment bias, respectively. The ICD-10 subtype-stratified mortality aORs ranged from 3.36 to 8.28 across five strata (exploratory; no formal interaction test performed). PSM (3884 pairs; n = 7768) and ground-level fall restriction produced estimates consistent with the primary analyses. Conclusions: Concomitant polytrauma was independently associated with substantially higher in-hospital mortality and non-home discharge after fall-related PHF, identifying a high-risk subgroup that warrants closer clinical attention.