Do orthopedic surgeons pay sufficient attention to osteoporosis in elderly patients with hip fragility fractures? A retrospective cohort study of a tertiary general hospital in China

Do orthopedic surgeons pay sufficient attention to osteoporosis in elderly patients with hip fragility fractures? 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A retrospective cohort study of a tertiary general hospital in China Miao Chen, Xingzhou Wei, Xu Zhang, Feng Zhu, Yijun Wang, Xiaoyang Wu, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6662537/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Summary: Timely management of osteoporosis is vitally important for elderly patients with hip fragility fractures. Our study revealed age-related enhancements in diagnostic and therapeutic rates in this population, with notable improvements facilitated by enhanced recovery after surgery (ERAS) protocols. Heightening awareness among orthopedic surgeons regarding the importance of osteoporosis is necessary. Introduction: The implementation of standardized diagnostic and treatment protocols for osteoporosis in elderly patients with fractures has the potential to prevent subsequent fractures. This study aims to analyze the diagnosis and treatment of osteoporosis in elderly patients who have experienced hip fragility fractures over a six-year period at a single medical center. Additionally, this study assessed whether enhanced recovery after surgery (ERAS) protocols could ameliorate the diagnosis and treatment of osteoporosis in these patients. Methods: The study included patients aged 60 years or older who suffered hip fractures and were hospitalized in a tertiary general hospital in China during the years 2017-2022. The database search yielded 3,141 patients, and a determination was made regarding the proportion of patients who received a diagnosis, examination, and treatment for osteoporosis following a fracture occurrence. Results: Among these patients, 558 individuals (17.8%) were diagnosed with osteoporosis, 470 (15.0%) underwent bone mineral density scans, 532 (16.9%) had their bone turnover markers assessed, and 2,403 (76.5%) received treatment for osteoporosis. The outcomes showed significant improvement over the years as patients aged (p < 0.01). Meanwhile, among the 3,002 patients who underwent surgical treatment, the diagnosis and treatment rates of osteoporosis in patients managed by ERAS mode were significantly higher than those not managed by ERAS mode (p < 0.01). Conclusion: Orthopedic surgeons often underestimate the importance of osteoporosis in elderly patients with hip fragility fractures, which could lead to missed opportunities for timely diagnosis and proper treatment. Perioperative ERAS management can reduce the missed diagnosis and treatment rates of osteoporosis. Hip fragility fracture Osteoporosis Diagnosis Therapeutics Fracture prevention Enhanced recovery after surgery Figures Figure 1 Figure 2 Introduction Osteoporosis is a systemic skeletal disorder characterized by a decrease in bone density and quality, as well as the deterioration of bone microstructure, due to various factors 1 ; 2 . Fragility fractures, also known as osteoporotic fractures, occur as a result of low-energy, non-violent falls that happen while a person is in a standing or lower position 2 ; 3 . The condition mentioned above is characterized as a bone tissue lesion that results from osteoporosis in the elderly. It serves as a prominent indicator of reduced bone strength and represents one of the most severe outcomes of osteoporosis. Therefore, individuals who present with hip fragility fractures can be diagnosed directly with osteoporosis 4 – 7 . Fractures caused by osteoporosis have placed significant social and economic burdens on both developed and developing countries 8 – 10 . In 2015, China experienced a staggering number of approximately 2.69 million incidents of major osteoporotic fractures, including those affecting the hips, vertebrae, and wrists. It is projected that there will be an estimated 4.83 million new cases reported in 2035, with an increase to approximately 5.99 million new cases in 2050 11 . Hip fractures are relatively common and severe among elderly individuals with osteoporosis. It is associated with a high disability rate of up to 50% and a one-year mortality rate of 20–30% 12; 13 . Due to its significant impact, it is often referred to as "the last fracture in life" 14 . According to estimates, the number of hip fractures in the year 2000 was approximately 1.6 million. However, it is projected that this figure will significantly increase to a range of 7.3 million to 21.3 million by the year 2050. It is worth noting that the most significant increase in hip fractures is expected to occur in the Asian region 15 ; 16 . It is important to note that the risk of subsequent fractures substantially increases following a fragility fracture 17 ; 18 . Within the first year after a hip fracture, patients may experience a significant decrease in bone mineral density in the femoral neck on the contralateral side to the fracture 19 – 21 . Studies have reported that the incidence of recurring fractures among individuals in this specific demographic can be as high as 8.11% within the second year. In addition, their rate of diagnosis and treatment for osteoporosis prior to re-fractures is remarkably low 22 ; 23 . Treatment of osteoporosis after hip fragility fractures reduces the risk of re-fracture and mortality 24 – 26 . However, despite the occurrence of hip fractures, the diagnosis and treatment rates for osteoporosis remain alarmingly low, ranging from 5–25% 27–29 . The assessment and standardized treatment of osteoporosis were also significantly inadequate. One contributing factor to this phenomenon is the prevailing belief among orthopedic surgeons that the management of osteoporosis following fracture treatment falls outside their area of responsibility 30 . Enhanced recovery after surgery (ERAS) is a modern perioperative management approach that aims to implement evidence-based measures to reduce the body's stress response to surgical trauma, minimize complications, improve surgical safety, and promote patient recovery. The primary goal of ERAS is to accelerate patient recovery and facilitate their timely reintegration into society 31 ; 32 . The implementation of the ERAS concept has seen significant advancements within the orthopedic field in recent years, which is indicative of its safety and effectiveness. However, there is a lack of research that investigated the clinical effectiveness of ERAS in the context of osteoporosis 33 ; 34 . The aim of this study was to evaluate the frequency of osteoporosis diagnosis, assessment, and treatment in individuals with hip fragility fractures, and to investigate the influence of ERAS on the management of osteoporosis in these people. The goal was to increase awareness among clinicians and patients about osteoporosis and reduce the negative outcomes associated with the condition. Methods The study was conducted at The First Affiliated Hospital of Soochow University, China, which is a tertiary general hospital with a strong reputation for orthopedic surgery. This is a retrospective cohort study using a large administrative database. The study has been approved by the institutional review committee of The First Affiliated Hospital of Soochow University (2023 Ethical Research Approval No. 188). 1. Patients A total of 3,141 patients was selected from the hospitalization records of patients aged 60 years or older who had experienced hip fragility fractures between January 1, 2017, and December 31, 2022, at The First Affiliated Hospital of Soochow University (Fig. 1 ). 2. Statistics The key statistical indicators were: (1) the misdiagnosis rate, which refers to the proportion of patients who are discharged without a diagnosis of osteoporosis; (2) the missed detection rate, which refers to the rate at which bone density and bone metabolism indicators are not examined; and (3) the under-treatment prevalence, which refers to the unused rate of foundational medications (calcium, vitamin D) and anti-osteoporosis drugs (bisphosphonates, denosumab, parathyroid hormone, calcitonin, traditional Chinese medicine) in the treatment of osteoporosis. 3. Grouping The criteria for grouping include: (1) comparison of these three statistics in different years that included 2017, 2018, 2019, 2020, 2021 and 2022; (2) comparison of these three statistics across different age groups that included 60–64, 65–69, 70–74, 75–79, 80–84, 85–89 and ≥ 90; (3) comparison of different perioperative management approaches: whether to adopt ERAS management during the perioperative period. 4. Analysis of bone turnover markers (BTMs) abnormalities Serum levels of β-crosslaps (CTX) and procollagen type 1 N-terminal propeptide (PINP) at hospital admission were measured using an electrochemiluminescence immunoassay (ECLIA, Roche Cobas platform). Elevated bone turnover markers were defined based on our institutional laboratory's reference values: CTX > 0.65 ng/mL, PINP > 55 ng/mL. The proportions of patients with isolated elevation of CTX, isolated elevation of PINP, or combined elevations of both markers were calculated to evaluate bone turnover activity and osteoporosis risk. 5. ERAS protocol The specific perioperative components of the ERAS protocol (Table 1 ) concentrate on essential aspects that include perioperative blood, prevention of infection, perioperative pain, prevention of thrombosis, perioperative catheters, perioperative temperature, prevention of nausea and vomiting, and postoperative rehabilitation exercise. The anesthetic technique used for all cases was general anesthesia. The closed reduction and internal fixation surgery were performed with the patient in a supine position on a traction bed. Total hip arthroplasty or hemiarthroplasty surgery was performed with a posterolateral or lateral approach with the patients in a lateral position. Table 1 Perioperative management measures Surgical day diet A minimal fasting was required (clear oral fluids up to 2 h before surgery) Management of perioperative blood 1. Nutritional meals were provided and administer MAP if hemoglobin (Hb) level is Hb < 70g/L 2. Prior to incision, 2g of tranexamic acid (TXA) is administered via IV drip 5–10 minutes before surgery excluding patients with a history of stroke, venous thromboembolism (VTE), epilepsy, allergy to TXA, and severe coronary heart disease 3. Postoperative application of ice packs and appropriate compression Prevention of infection 1. Preoperative improvement of anemia and hypoalbuminemia 2. Prophylactic use of cefazolin sodium 1.0g 0.5-2 hours before surgery 3. Surgeries conducted in laminar flow ultra purification operating rooms 4. Reduction of the number of individuals present during surgery 5. Wearing protective back-style surgical gowns 6. Surgeons wearing double-layered gloves 7. Prophylactic use of antibiotics for 48 hours postoperatively Management of perioperative pain 1. Preoperative oral administration of celecoxib 200mg twice daily 2. A local "cocktail" infiltration injection (150mg of ropivacaine + 1g of TXA + 20ml of saline) before suturing 3. Postoperative intravenous injection of parecoxib sodium 40mg bid or injection of ketorolac tromethamine 30mg qd for 3–7 days 4. Tramadol injection 100mg intramuscularly as needed 5. Continue to use celecoxib 200mg twice daily after discharge until 4 weeks postoperatively Prevention of thrombosis 1. Health education 2. Routine preoperative lower extremity vascular color Doppler ultrasound to rule out lower extremity deep vein thrombosis (DVT), followed by routine use of graduated compression stockings (ES) 3. Subcutaneous injection of low molecular weight heparin 12–24 hours after surgery 4. Oral administration of rivaroxaban 20mg qd until 5 weeks after discharge Management of perioperative catheters 1. Urinary catheters are not routinely placed, except for elderly female patients who may require catheterization during surgery, which is subsequently removed upon completion of the procedure 2. Drainage tubes are not routinely placed Management of perioperative temperature 1. Anesthesia is administered only when the core body temperature is ≥ 36℃ 2. During the procedure, warming blankets are used, and all exposed areas are covered for protection 3. All fluids and irrigation solutions are warmed to 37℃ 4. The operating room temperature is maintained at ≥ 21℃ 5. After the surgery, patients are transferred back to the ward when their core body temperature is ≥ 36℃. Prevention of nausea and vomiting 1. Preoperative correction of water and electrolyte disturbances is essential 2. Prior to anesthesia induction, intravenous injection of 5mg dexamethasone is recommended 3. Postoperatively, small frequent meals are advised 4. Positioning the patient with the head elevated at 40°-50° and the feet elevated at 30° to prevent positional complications 5. Routine intravenous injection of ondansetron 4mg is recommended, with the option to additionally use 1.5mg scopolamine patches locally if necessary Postoperative rehabilitation exercise 1. Before the surgery, the rehabilitation therapist instructs on muscle lengthening and contraction training 2. Two hours after returning to the ward post-surgery, the therapist guides the patient on muscle lengthening and stretching exercises 3. On the first day after the surgery, the therapist assists with walking using a walker and provides training on gait and stationary stepping 4. Between 3–5 days post-surgery, the patient can independently use a walker to go to the bathroom and can be discharged after walking continuously for over 60 meters 6. Statistical Analysis The chi-square test for trend (Cochran-Armitage trend test4) was performed. Statistical computation was performed using IBM SPSS (version 26, SPSS, Inc., Chicago, IL, USA). The applied level of significance was p < 0.05. Results 1.Patient Selection The current study analyzed the medical records of 3141 inpatients aged 60 years or older with hip fragility fractures between January 2017 and December 2022, after exclusion of patients with non-fragility fractures, such as high-energy injuries or pathological conditions. In this study, 250 patients (8.0 percent) were aged sixty to sixty-four; 379 patients (12.1 percent) were aged sixty-five to sixty-nine; 426 patients (13.6 percent) were aged seventy to seventy-four; 505 patients (16.1 percent) were aged seventy-five to seventy-nine; 567 (18.1 percent) were aged eighty to eighty-four; 602 (19.2 percent) were aged eighty-five to ninety; and 412 (13.1 percent) were aged ninety or older. The mean age of the study population was 78.9 ± 9.3 years. 2. Diagnosis of Osteoporosis As mentioned previously, the study population comprised patients with hip fragility fractures, who were identified as individuals with osteoporosis. Out of the 3,141 patients, 2,583 were not diagnosed with osteoporosis, which indicated a missed diagnosis rate as high as 82.2%. 3. Examination of osteoporosis Out of 3,141 patients with hip fragility fractures, 2,671 did not undergo bone mineral density (BMD) tests, and 2609 did not undergo BTMs evaluations. All 470 patients who underwent bone-density scans were treated with dual-energy X-ray absorptiometry (DEXA) scans. 4. Treatment of Osteoporosis Among the 3,141 patients, 2,403 received appropriate anti-osteoporosis treatment, which is defined as the use of at least one prescription approved for the treatment of confirmed osteoporosis. Out of the 2,403 patients who received treatment, 1,070 received only basic anti-osteoporosis treatment, which consisted of calcium tablets and/or vitamin D. 5. Rate of patients with abnormal BTMs A total of 532 patients underwent serum CTX and PINP measurements at admission. Of these, isolated elevation of CTX was observed in 104 patients (19.55%), isolated elevation of PINP in 52 patients (9.77%), and combined elevations of both CTX and PINP in 146 patients (27.44%). Collectively, 302 patients (56.77%) exhibited abnormal elevations in CTX and/or PINP, indicating that more than half of the patients had significantly increased bone turnover at admission, necessitating clinical attention to their osteoporosis risk (Table 2 ). Table 2 Rate of patients with abnormal BTMs Abnormal BTMs Number of Patients (n = 532) Percentage (%) Elevated CTX only 104 19.55% Elevated PINP only 52 9.77% Both CTX and PINP elevated 146 27.44% Total (any elevated marker) 302 56.77% 6. Rate of Diagnosis, Examination and Treatment of Osteoporosis by Fracture Date. An annual analysis was conducted to determine whether there was any change in the diagnosis, examination, and treatment rates of osteoporosis during the six-year study period ( Table 3 & Fig. 2 ). There was a notable increase in the rate of diagnosis and treatment in 2021 and 2022 compared to previous years (p < 0.01), as well as a significant rise in the rate of examination in 2021 and 2022 compared to the previous year (p < 0.01). Table 3. Rate of Diagnosis, Examination and Treatment of Osteoporosis by Fracture Date Fracture date by year 2017 2018 2019 2020 2021 2022 P Patients studied, n 458 565 572 481 556 509 - Diagnosed, n (%) 14(3.1) 27(4.8) 16(2.8) 13(2.7) 156(28.1) 332(65.2) 0.000 * BMD, n (%) 96(21.0) 60(10.6) 50(8.7) 24(5.0) 85(15.3) 155(30.5) 0.000 ** BTMs, n (%) 145(31.7) 123(21.8) 72(12.6) 17(3.5) 49(8.8) 127(25.0) 0.000 ** Treated, n (%) 314(68.6) 395(69.9) 413(72.7) 338(70.3) 467(84.0) 476(93.5) 0.000 * * There was a significant upward trend in the rate of diagnosis and treatment in 2021 and 2022 compared to any previous years ( p < 0.01, chi-square test for trend). ** There was a significant upward trend in the rate of examination in 2021 and 2022 compared to the previous year ( p < 0.01, chi-square test for trend). 7. Rate of Diagnosis, Examination and Treatment of Osteoporosis by Patient Age The rates of diagnosis, examination, and treatment of osteoporosis by patient age at the time of the hip fracture, in five-year intervals, are presented in Table 4 . The chi-square test for trend was utilized to examine the trend in the rate of osteoporosis diagnosis, examination, and treatment across different age groups. As patients aged, the diagnostic rate showed a significant upward trend (p < 0.01). Table 4. Rate of Diagnosis, Examination and Treatment of Osteoporosis by Patient Age Age (yrs.) Patients studied, n Diagnosed * , n (%) BMD, n (%) BTMs, n (%) Treatment, n (%) 60–64 250 23(9.2) 34(13.6) 35(14.0) 184(73.6) 65–69 379 63(16.6) 52(13.7) 60(15.8) 275(72.6) 70–74 426 71(16.7) 48(11.3) 57(13.4) 329(77.2) 75–79 505 90(17.8) 93(18.4) 94(18.6) 401(79.4) 80–84 567 105(18.5) 101(17.8) 104(18.3) 446(78.7) 85–89 602 115(19.1) 81(13.5) 104(17.3) 467(77.6) 95 or older 412 91(22.1) 61(14.8) 79(19.2) 301(73.1) Full sample 3,141 558(17.8) 470(15.0) 533(17.0) 2,403(76.5) *There was a significant upward trend in the rate of diagnosis as patients aged ( p = 0.003, chi-square test for trend). 8. Rate of Diagnosis, Examination and Treatment of Osteoporosis by ERAS Adoption Among the 3,141 patients, 3,002 received surgical treatment. The rates of differences in diagnosis, examination, and treatment based on whether the patient adopted ERAS management mode during the perioperative period were compared and are presented in Table 5 in a six-year investigation. The chi-square test for trend revealed a significant difference in the rates of diagnosis, the rates of BMD, the rates of BTMs and treatment between the ERAS group and the non-ERAS group (p < 0.01). Table 5. Rate of Diagnosis, Examination and Treatment of Osteoporosis by ERAS Adoption Item Full sample ERAS Non-ERAS P Patients studied, n 3,002 1,722 1,280 - Diagnosed, n (%) 508(16.9) 442(25.7) 66(5.2) 0.000 * BMD, n (%) 459(15.3) 393(22.8) 66(5.2) 0.000 * BTMs, n (%) 512(17.1) 372(21.6) 140(10.9) 0.000 * Treated, n (%) 2,370(78.9) 1,635(94.9) 735(57.4) 0.000 * * There was a significant difference in the rates of diagnosis, BMD, BTMs and treatment between the ERAS group and the non-ERAS group (p < 0.01, chi-square test for trend). Discussion The incidence of osteoporotic fractures has been increasing due to the progressive aging of the global population. According to estimates, the number of osteoporotic fractures in China is expected to rise to 4.83 million by 2035 and 5.99 million by 2050 35 . If osteoporosis can be diagnosed promptly and accurately, and treated systematically and effectively, the risk of osteoporotic fractures will be greatly reduced 24 ; 36 ; 37 . Therefore, this study aimed to assess the effectiveness of diagnosis, examination, and treatment of osteoporosis in elderly patients after hip fragility fractures. In the present study, hip fractures caused by low energy in individuals aged 60 and above were classified as osteoporotic fractures. This classification was based on two key factors. Firstly, the World Health Organization (WHO) designates individuals aged 60–65 and above as elderly. Secondly, osteoporotic fractures are caused by low-energy trauma. By comparison of data grouped by year, it was observed that the diagnosis rate of osteoporosis has increased from 3.1% in 2017 to 65.2% in 2022, with the most significant increase observed in 2021 and 2022. Similar patterns were also observed in the rates of treatment. The treatment rate experienced a significant increase, which rose from 68.6% in 2017 to 93.5% in 2022. Another significant aspect of the current study was to investigate the potential of perioperative ERAS management in reduction of the misdiagnosis rate of osteoporosis. A comparative analysis revealed that the rate of diagnosis in the ERAS group (25.7%) was significantly higher compared to the non-ERAS group (5.2%). The overall diagnosis rate for the entire sample was found to be 16.9%. Therefore, this provides strong evidence for the reduction of misdiagnosis rates of osteoporosis in ERAS management during the perioperative period. Overall, the presented data indicate a progressive increase in the level of attention dedicated by medical personnel to the management of osteoporosis over the years. This study also revealed that 56.77% of patients with hip fragility fractures had abnormal elevations of serum CTX and/or PINP levels at admission. Particularly, isolated elevation of bone resorption marker (CTX) or combined elevations of both bone resorption (CTX) and formation markers (PINP) were prevalent. This indicates markedly increased bone turnover in this patient population, potentially accelerating bone loss and increasing osteoporosis risk, thereby elevating the likelihood of subsequent fractures 38 . Isolated elevation of CTX indicates excessive bone resorption activity, whereas concurrent elevation of both CTX and PINP indicates overall accelerated bone remodeling, where compensatory bone formation might still fail to prevent net bone loss 38 – 40 . Therefore, we recommend routine assessment of bone turnover markers upon admission to facilitate early identification and targeted osteoporosis intervention. Moreover, baseline CTX and PINP measurements at admission provide valuable reference points for monitoring therapeutic response and bone metabolism changes during follow-up 41 . Despite the relatively low diagnosis rate of osteoporosis, it is fortunate that the treatment rate for this condition is high. Patients who adhere to ERAS protocols show a significantly higher rate of treatment for osteoporosis. The authors’ ward initiated the implementation of ERAS management in May 2016, which was later expanded to include all patients undergoing joint arthroplasty and those with hip fractures. Therefore, starting from 2017, the patients were divided into two groups: the ERAS group and the non-ERAS group, based on whether they adopted ERAS management during the perioperative period. Since 2022, our hospital has implemented ERAS management for all hip fracture patients, based on the positive outcomes associated with this approach. Consequently, the dataset for the non-ERAS group does not include data from the year 2022. There are limitations that should be noted in this study. This is a single-center retrospective study, which may introduce bias. In addition, only hip fractures were included in the analysis, while other major osteoporotic fractures, such as vertebral, proximal humerus, and distal radius fractures, were not considered in the assessment of osteoporosis diagnosis and treatment. However, there are multiple strengths to consider, which include a sample size of over 3,000 cases and the inclusion of a representative sample from a typical Chinese tertiary general hospital. Conclusion The diagnosis rate of osteoporosis in elderly individuals with hip fragility fractures is relatively low. However, the rate of treatment for this condition is significantly higher than the rate of diagnosis and shows gradual improvement over time. The frequency of bone mineral density testing is also relatively low. ERAS has the potential to improve the rates of diagnosis and treatment for osteoporosis. Declarations Ethics approval and consent to participate The Medical Ethics Committee of The First Affiliated Hospital of Soochow University approved the study protocol and waived the need for patient informed consent owing to the retrospective nature of the study (Reference Number: (2023) Ethical Research Approval No. 188). The study was conducted in accordance with the principles of the Declaration of Helsinki of 1975 (as amended in 1983). Conflict of Interest The authors declare that they have no conflict of interest. Funding This study was funded by the Innovation Center Project of Orthopedic Surgery in Jiangsu Province (CXZX202209), the Special Project of Diagnosis and Treatment Technology for Key Clinical Diseases in Suzhou (LCZX202302 and LCZX202304) and the Key Project of “Strengthening Health through Science and Education” in Suzhou (ZDXM2024001). Author Contribution Conceptualization: Jun Zhou, Miao Chen, Wei Wang, Yan Lu; Data curation: Xu Zhang, Miao Chen, Xingzhou Wei, Quan Zhou, Xiaoyang Wu, Hanrong Xia; Formal Analysis: Yan Lu, Xingzhou Wei, Feng Zhu, Yijun Wang, Tong Jin; Writing-original draft: Miao Chen. Writing-review & editing: Jun Zhou, Yaozeng Xu, Lianfang Zhang. Supervision: Jun Zhou. Acknowledgement We thank Prof. Timothy E. Hewett of Department of Orthopaedic Surgery, Marshall University, Huntington, West Virginia, USA for his review and advices of this manuscript. 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Bone Turnover Markers: Basic Biology to Clinical Applications. Endocr Rev 44:417-473. Szulc P, Delmas PD. 2008. Biochemical markers of bone turnover: potential use in the investigation and management of postmenopausal osteoporosis. Osteoporosis International 19:1683-1704. Szulc P. 2018. Bone turnover: Biology and assessment tools. Best Pract Res Cl En 32:725-738. Langdahl BL. 2018. Is There a Place for Bone Turnover Markers in the Management of Osteoporosis? Journal of Bone and Mineral Research 33:1197-1198. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6662537","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471894404,"identity":"71666006-0e3a-49b7-a7a0-53ee3ba6b185","order_by":0,"name":"Miao Chen","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Miao","middleName":"","lastName":"Chen","suffix":""},{"id":471894407,"identity":"c09017f2-d5ba-46ec-9917-24d5c749cc23","order_by":1,"name":"Xingzhou Wei","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Xingzhou","middleName":"","lastName":"Wei","suffix":""},{"id":471894410,"identity":"4da60e4b-df02-48be-9724-d8a9c1a491f8","order_by":2,"name":"Xu Zhang","email":"","orcid":"","institution":"Suzhou Medical College of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Xu","middleName":"","lastName":"Zhang","suffix":""},{"id":471894412,"identity":"f232d7de-ec02-4b18-9086-8dc114b9262e","order_by":3,"name":"Feng Zhu","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Feng","middleName":"","lastName":"Zhu","suffix":""},{"id":471894413,"identity":"df8b3869-0c6d-4fa2-aa99-b577ed80c500","order_by":4,"name":"Yijun Wang","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Yijun","middleName":"","lastName":"Wang","suffix":""},{"id":471894414,"identity":"a95be5d9-0d54-4882-9a44-bfe9a86ab2f1","order_by":5,"name":"Xiaoyang Wu","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoyang","middleName":"","lastName":"Wu","suffix":""},{"id":471894415,"identity":"caa7c743-a6d0-44b4-a656-c492c832b5bb","order_by":6,"name":"Tong Jin","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Tong","middleName":"","lastName":"Jin","suffix":""},{"id":471894416,"identity":"efaa3df4-981a-4a8f-b0c2-5da012ad884a","order_by":7,"name":"Hanrong Xia","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Hanrong","middleName":"","lastName":"Xia","suffix":""},{"id":471894417,"identity":"dcf85354-e86b-4c1b-8a60-075a7b5e9d1e","order_by":8,"name":"Quan Zhou","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Quan","middleName":"","lastName":"Zhou","suffix":""},{"id":471894418,"identity":"37b766ec-6b24-469a-a9eb-9b5315fe7c9f","order_by":9,"name":"Lianfang Zhang","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Lianfang","middleName":"","lastName":"Zhang","suffix":""},{"id":471894419,"identity":"da3a5b92-2a91-462d-9167-454bf40c70d1","order_by":10,"name":"Yaozeng Xu","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Yaozeng","middleName":"","lastName":"Xu","suffix":""},{"id":471894420,"identity":"1cd7fb4b-67ac-43b7-bf0a-43a27fc20b3a","order_by":11,"name":"Wei Wang","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Wang","suffix":""},{"id":471894421,"identity":"d5b357a4-4600-4536-bdea-f3ee68b2696a","order_by":12,"name":"Yan Lu","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Lu","suffix":""},{"id":471894422,"identity":"619b4bc0-eda1-46cd-95f4-6e0655fc848c","order_by":13,"name":"Jun Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYDACCRDBA+V8bACRjI0HiNbCOLMBxGdsIEILFDDzNkD4eLXIz24+JsEgcziPQfrwMWnbHTZ1uu2HgbbU2ETj0sI451iaBAPP4WIGvrQ06dwzaRJmZxKBWo6l5Tbg0MIskWMG0pLYwMNjJp3bdljC7ABQC2PDYZxa2FC0WIK0nH+IXwsPihZGkJYbBGyRkEhLtkjgSU9s42FLtuxtS5PcdgNoSwIev8jPSD5442OPdWI/D/PBGz/bbPjNzqc/fPChxganFjBI7AF6ioGBBRFHCfiUg8EPMMn8gaDCUTAKRsEoGJEAALmMVfUfmgaaAAAAAElFTkSuQmCC","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":true,"prefix":"","firstName":"Jun","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2025-05-14 09:23:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6662537/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6662537/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84919058,"identity":"5347733e-ab8d-48ea-b4c8-9c3533b5d887","added_by":"auto","created_at":"2025-06-18 19:30:01","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":190753,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of participants\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6662537/v1/37f3e3feecddd2d63890a4de.jpeg"},{"id":84921225,"identity":"6181c158-ee64-4cd8-8e00-44f2fa9b1520","added_by":"auto","created_at":"2025-06-18 19:46:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":216102,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in emphasis on osteoporosis by fracture date: the overall situation has significantly improved in 2021 and 2022.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6662537/v1/a08ed16c1e19af20273a44c2.png"},{"id":103398110,"identity":"9a024823-6abb-4dfa-b338-6995f4542036","added_by":"auto","created_at":"2026-02-25 08:58:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1182792,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6662537/v1/b01c1a6b-6799-42de-9594-43618a31038e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Do orthopedic surgeons pay sufficient attention to osteoporosis in elderly patients with hip fragility fractures? A retrospective cohort study of a tertiary general hospital in China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOsteoporosis is a systemic skeletal disorder characterized by a decrease in bone density and quality, as well as the deterioration of bone microstructure, due to various factors \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e; \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Fragility fractures, also known as osteoporotic fractures, occur as a result of low-energy, non-violent falls that happen while a person is in a standing or lower position \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e; \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The condition mentioned above is characterized as a bone tissue lesion that results from osteoporosis in the elderly. It serves as a prominent indicator of reduced bone strength and represents one of the most severe outcomes of osteoporosis. Therefore, individuals who present with hip fragility fractures can be diagnosed directly with osteoporosis \u003csup\u003e\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Fractures caused by osteoporosis have placed significant social and economic burdens on both developed and developing countries \u003csup\u003e\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In 2015, China experienced a staggering number of approximately 2.69\u0026nbsp;million incidents of major osteoporotic fractures, including those affecting the hips, vertebrae, and wrists. It is projected that there will be an estimated 4.83\u0026nbsp;million new cases reported in 2035, with an increase to approximately 5.99\u0026nbsp;million new cases in 2050 \u003csup\u003e11\u003c/sup\u003e. Hip fractures are relatively common and severe among elderly individuals with osteoporosis. It is associated with a high disability rate of up to 50% and a one-year mortality rate of 20\u0026ndash;30% \u003csup\u003e12; \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Due to its significant impact, it is often referred to as \"the last fracture in life\" \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. According to estimates, the number of hip fractures in the year 2000 was approximately 1.6\u0026nbsp;million. However, it is projected that this figure will significantly increase to a range of 7.3\u0026nbsp;million to 21.3\u0026nbsp;million by the year 2050. It is worth noting that the most significant increase in hip fractures is expected to occur in the Asian region \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e; \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIt is important to note that the risk of subsequent fractures substantially increases following a fragility fracture \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e; \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Within the first year after a hip fracture, patients may experience a significant decrease in bone mineral density in the femoral neck on the contralateral side to the fracture \u003csup\u003e\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Studies have reported that the incidence of recurring fractures among individuals in this specific demographic can be as high as 8.11% within the second year. In addition, their rate of diagnosis and treatment for osteoporosis prior to re-fractures is remarkably low \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e; \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Treatment of osteoporosis after hip fragility fractures reduces the risk of re-fracture and mortality \u003csup\u003e\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. However, despite the occurrence of hip fractures, the diagnosis and treatment rates for osteoporosis remain alarmingly low, ranging from 5\u0026ndash;25% \u003csup\u003e27\u0026ndash;29\u003c/sup\u003e. The assessment and standardized treatment of osteoporosis were also significantly inadequate. One contributing factor to this phenomenon is the prevailing belief among orthopedic surgeons that the management of osteoporosis following fracture treatment falls outside their area of responsibility \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEnhanced recovery after surgery (ERAS) is a modern perioperative management approach that aims to implement evidence-based measures to reduce the body's stress response to surgical trauma, minimize complications, improve surgical safety, and promote patient recovery. The primary goal of ERAS is to accelerate patient recovery and facilitate their timely reintegration into society \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e; \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. The implementation of the ERAS concept has seen significant advancements within the orthopedic field in recent years, which is indicative of its safety and effectiveness. However, there is a lack of research that investigated the clinical effectiveness of ERAS in the context of osteoporosis \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e; \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe aim of this study was to evaluate the frequency of osteoporosis diagnosis, assessment, and treatment in individuals with hip fragility fractures, and to investigate the influence of ERAS on the management of osteoporosis in these people. The goal was to increase awareness among clinicians and patients about osteoporosis and reduce the negative outcomes associated with the condition.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study was conducted at The First Affiliated Hospital of Soochow University, China, which is a tertiary general hospital with a strong reputation for orthopedic surgery. This is a retrospective cohort study using a large administrative database. The study has been approved by the institutional review committee of The First Affiliated Hospital of Soochow University (2023 Ethical Research Approval No. 188).\u003c/p\u003e\n\u003cp\u003e1. Patients\u003c/p\u003e\n\u003cp\u003eA total of 3,141 patients was selected from the hospitalization records of patients aged 60 years or older who had experienced hip fragility fractures between January 1, 2017, and December 31, 2022, at The First Affiliated Hospital of Soochow University (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e2. Statistics\u003c/p\u003e\n\u003cp\u003eThe key statistical indicators were: (1) the misdiagnosis rate, which refers to the proportion of patients who are discharged without a diagnosis of osteoporosis; (2) the missed detection rate, which refers to the rate at which bone density and bone metabolism indicators are not examined; and (3) the under-treatment prevalence, which refers to the unused rate of foundational medications (calcium, vitamin D) and anti-osteoporosis drugs (bisphosphonates, denosumab, parathyroid hormone, calcitonin, traditional Chinese medicine) in the treatment of osteoporosis.\u003c/p\u003e\n\u003cp\u003e3. Grouping\u003c/p\u003e\n\u003cp\u003eThe criteria for grouping include: (1) comparison of these three statistics in different years that included 2017, 2018, 2019, 2020, 2021 and 2022; (2) comparison of these three statistics across different age groups that included 60\u0026ndash;64, 65\u0026ndash;69, 70\u0026ndash;74, 75\u0026ndash;79, 80\u0026ndash;84, 85\u0026ndash;89 and \u0026ge;\u0026thinsp;90; (3) comparison of different perioperative management approaches: whether to adopt ERAS management during the perioperative period.\u003c/p\u003e\n\u003cp\u003e4. Analysis of bone turnover markers (BTMs) abnormalities\u003c/p\u003e\n\u003cp\u003eSerum levels of \u0026beta;-crosslaps (CTX) and procollagen type 1 N-terminal propeptide (PINP) at hospital admission were measured using an electrochemiluminescence immunoassay (ECLIA, Roche Cobas platform). Elevated bone turnover markers were defined based on our institutional laboratory\u0026apos;s reference values: CTX\u0026thinsp;\u0026gt;\u0026thinsp;0.65 ng/mL, PINP\u0026thinsp;\u0026gt;\u0026thinsp;55 ng/mL. The proportions of patients with isolated elevation of CTX, isolated elevation of PINP, or combined elevations of both markers were calculated to evaluate bone turnover activity and osteoporosis risk.\u003c/p\u003e\n\u003cp\u003e5. ERAS protocol\u003c/p\u003e\n\u003cp\u003eThe specific perioperative components of the ERAS protocol (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) concentrate on essential aspects that include perioperative blood, prevention of infection, perioperative pain, prevention of thrombosis, perioperative catheters, perioperative temperature, prevention of nausea and vomiting, and postoperative rehabilitation exercise. The anesthetic technique used for all cases was general anesthesia. The closed reduction and internal fixation surgery were performed with the patient in a supine position on a traction bed. Total hip arthroplasty or hemiarthroplasty surgery was performed with a posterolateral or lateral approach with the patients in a lateral position.\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePerioperative management measures\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSurgical day diet\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eA minimal fasting was required (clear oral fluids up to 2 h before surgery)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eManagement of perioperative blood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Nutritional meals were provided and administer MAP if hemoglobin (Hb) level is Hb\u0026thinsp;\u0026lt;\u0026thinsp;70g/L\u003c/p\u003e\n \u003cp\u003e2. Prior to incision, 2g of tranexamic acid (TXA) is administered via IV drip 5\u0026ndash;10 minutes before surgery excluding patients with a history of stroke, venous thromboembolism (VTE), epilepsy, allergy to TXA, and severe coronary heart disease\u003c/p\u003e\n \u003cp\u003e3. Postoperative application of ice packs and appropriate compression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrevention of infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Preoperative improvement of anemia and hypoalbuminemia\u003c/p\u003e\n \u003cp\u003e2. Prophylactic use of cefazolin sodium 1.0g 0.5-2 hours before surgery\u003c/p\u003e\n \u003cp\u003e3. Surgeries conducted in laminar flow ultra purification operating rooms\u003c/p\u003e\n \u003cp\u003e4. Reduction of the number of individuals present during surgery\u003c/p\u003e\n \u003cp\u003e5. Wearing protective back-style surgical gowns\u003c/p\u003e\n \u003cp\u003e6. Surgeons wearing double-layered gloves\u003c/p\u003e\n \u003cp\u003e7. Prophylactic use of antibiotics for 48 hours postoperatively\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eManagement of perioperative pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Preoperative oral administration of celecoxib 200mg twice daily\u003c/p\u003e\n \u003cp\u003e2. A local \u0026quot;cocktail\u0026quot; infiltration injection (150mg of ropivacaine\u0026thinsp;+\u0026thinsp;1g of TXA\u0026thinsp;+\u0026thinsp;20ml of saline) before suturing\u003c/p\u003e\n \u003cp\u003e3. Postoperative intravenous injection of parecoxib sodium 40mg bid or injection of ketorolac tromethamine 30mg qd for 3\u0026ndash;7 days\u003c/p\u003e\n \u003cp\u003e4. Tramadol injection 100mg intramuscularly as needed\u003c/p\u003e\n \u003cp\u003e5. Continue to use celecoxib 200mg twice daily after discharge until 4 weeks postoperatively\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrevention of thrombosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Health education\u003c/p\u003e\n \u003cp\u003e2. Routine preoperative lower extremity vascular color Doppler ultrasound to rule out lower extremity deep vein thrombosis (DVT), followed by routine use of graduated compression stockings (ES)\u003c/p\u003e\n \u003cp\u003e3. Subcutaneous injection of low molecular weight heparin 12\u0026ndash;24 hours after surgery\u003c/p\u003e\n \u003cp\u003e4. Oral administration of rivaroxaban 20mg qd until 5 weeks after discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eManagement of perioperative catheters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Urinary catheters are not routinely placed, except for elderly female patients who may require catheterization during surgery, which is subsequently removed upon completion of the procedure\u003c/p\u003e\n \u003cp\u003e2. Drainage tubes are not routinely placed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eManagement of perioperative temperature\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Anesthesia is administered only when the core body temperature is \u0026ge;\u0026thinsp;36℃\u003c/p\u003e\n \u003cp\u003e2. During the procedure, warming blankets are used, and all exposed areas are covered for protection\u003c/p\u003e\n \u003cp\u003e3. All fluids and irrigation solutions are warmed to 37℃\u003c/p\u003e\n \u003cp\u003e4. The operating room temperature is maintained at \u0026ge;\u0026thinsp;21℃\u003c/p\u003e\n \u003cp\u003e5. After the surgery, patients are transferred back to the ward when their core body temperature is \u0026ge;\u0026thinsp;36℃.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrevention of nausea and vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Preoperative correction of water and electrolyte disturbances is essential\u003c/p\u003e\n \u003cp\u003e2. Prior to anesthesia induction, intravenous injection of 5mg dexamethasone is recommended\u003c/p\u003e\n \u003cp\u003e3. Postoperatively, small frequent meals are advised\u003c/p\u003e\n \u003cp\u003e4. Positioning the patient with the head elevated at 40\u0026deg;-50\u0026deg; and the feet elevated at 30\u0026deg; to prevent positional complications\u003c/p\u003e\n \u003cp\u003e5. Routine intravenous injection of ondansetron 4mg is recommended, with the option to additionally use 1.5mg scopolamine patches locally if necessary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative rehabilitation exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Before the surgery, the rehabilitation therapist instructs on muscle lengthening and contraction training\u003c/p\u003e\n \u003cp\u003e2. Two hours after returning to the ward post-surgery, the therapist guides the patient on muscle lengthening and stretching exercises\u003c/p\u003e\n \u003cp\u003e3. On the first day after the surgery, the therapist assists with walking using a walker and provides training on gait and stationary stepping\u003c/p\u003e\n \u003cp\u003e4. Between 3\u0026ndash;5 days post-surgery, the patient can independently use a walker to go to the bathroom and can be discharged after walking continuously for over 60 meters\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e6. Statistical Analysis\u003c/p\u003e\n\u003cp\u003eThe chi-square test for trend (Cochran-Armitage trend test4) was performed. Statistical computation was performed using IBM SPSS (version 26, SPSS, Inc., Chicago, IL, USA). The applied level of significance was p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1.Patient Selection\u003c/p\u003e\n\u003cp\u003eThe current study analyzed the medical records of 3141 inpatients aged 60 years or older with hip fragility fractures between January 2017 and December 2022, after exclusion of patients with non-fragility fractures, such as high-energy injuries or pathological conditions. In this study, 250 patients (8.0 percent) were aged sixty to sixty-four; 379 patients (12.1 percent) were aged sixty-five to sixty-nine; 426 patients (13.6 percent) were aged seventy to seventy-four; 505 patients (16.1 percent) were aged seventy-five to seventy-nine; 567 (18.1 percent) were aged eighty to eighty-four; 602 (19.2 percent) were aged eighty-five to ninety; and 412 (13.1 percent) were aged ninety or older. The mean age of the study population was 78.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3 years.\u003c/p\u003e\n\u003cp\u003e2. Diagnosis of Osteoporosis\u003c/p\u003e\n\u003cp\u003eAs mentioned previously, the study population comprised patients with hip fragility fractures, who were identified as individuals with osteoporosis. Out of the 3,141 patients, 2,583 were not diagnosed with osteoporosis, which indicated a missed diagnosis rate as high as 82.2%.\u003c/p\u003e\n\u003cp\u003e3. Examination of osteoporosis\u003c/p\u003e\n\u003cp\u003eOut of 3,141 patients with hip fragility fractures, 2,671 did not undergo bone mineral density (BMD) tests, and 2609 did not undergo BTMs evaluations. All 470 patients who underwent bone-density scans were treated with dual-energy X-ray absorptiometry (DEXA) scans.\u003c/p\u003e\n\u003cp\u003e4. Treatment of Osteoporosis\u003c/p\u003e\n\u003cp\u003eAmong the 3,141 patients, 2,403 received appropriate anti-osteoporosis treatment, which is defined as the use of at least one prescription approved for the treatment of confirmed osteoporosis. Out of the 2,403 patients who received treatment, 1,070 received only basic anti-osteoporosis treatment, which consisted of calcium tablets and/or vitamin D.\u003c/p\u003e\n\u003cp\u003e5. Rate of patients with abnormal BTMs\u003c/p\u003e\n\u003cp\u003eA total of 532 patients underwent serum CTX and PINP measurements at admission. Of these, isolated elevation of CTX was observed in 104 patients (19.55%), isolated elevation of PINP in 52 patients (9.77%), and combined elevations of both CTX and PINP in 146 patients (27.44%). Collectively, 302 patients (56.77%) exhibited abnormal elevations in CTX and/or PINP, indicating that more than half of the patients had significantly increased bone turnover at admission, necessitating clinical attention to their osteoporosis risk (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRate of patients with abnormal BTMs\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAbnormal BTMs\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of Patients (n\u0026thinsp;=\u0026thinsp;532)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eElevated CTX only\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.55%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eElevated PINP only\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.77%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBoth CTX and PINP elevated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.44%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (any elevated marker)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.77%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e6. Rate of Diagnosis, Examination and Treatment of Osteoporosis by Fracture Date.\u003c/p\u003e\n\u003cp\u003eAn annual analysis was conducted to determine whether there was any change in the diagnosis, examination, and treatment rates of osteoporosis during the six-year study period (\u003cstrong\u003eTable\u0026nbsp;3\u003c/strong\u003e \u0026amp; \u003cstrong\u003eFig.\u0026nbsp;2\u003c/strong\u003e). There was a notable increase in the rate of diagnosis and treatment in 2021 and 2022 compared to previous years (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), as well as a significant rise in the rate of examination in 2021 and 2022 compared to the previous year (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"9\" style=\"width: 99.9144%;\"\u003e\u0026nbsp;Table 3. Rate of Diagnosis, Examination and Treatment of Osteoporosis by Fracture Date\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eFracture\u003c/p\u003e\n \u003cp\u003edate by year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePatients studied, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e572\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDiagnosed,\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156(28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e332(65.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBMD, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96(21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60(10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85(15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155(30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBTMs, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145(31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123(21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72(12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49(8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTreated, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e314(68.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e395(69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e413(72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e338(70.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e467(84.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e476(93.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"9\" style=\"width: 99.9145%;\"\u003e\u0026nbsp;* There was a significant upward trend in the rate of diagnosis and treatment in 2021 and 2022 compared to any previous years (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, chi-square test for trend).\u003cp\u003e** There was a significant upward trend in the rate of examination in 2021 and 2022 compared to the previous year (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, chi-square test for trend).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e7. Rate of Diagnosis, Examination and Treatment of Osteoporosis by Patient Age\u003c/p\u003e\n\u003cp\u003eThe rates of diagnosis, examination, and treatment of osteoporosis by patient age at the time of the hip fracture, in five-year intervals, are presented in \u003cstrong\u003eTable\u0026nbsp;4\u003c/strong\u003e. The chi-square test for trend was utilized to examine the trend in the rate of osteoporosis diagnosis, examination, and treatment across different age groups. As patients aged, the diagnostic rate showed a significant upward trend (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tabb\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"7\" style=\"width: 99.8782%;\"\u003e\n \u003cp\u003eTable 4. Rate of Diagnosis, Examination and Treatment of Osteoporosis by Patient Age\u0026nbsp;\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e(yrs.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatients studied, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiagnosed\u003csup\u003e*\u003c/sup\u003e,\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMD,\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBTMs,\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTreatment,\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u0026ndash;64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23(9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34(13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e184(73.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u0026ndash;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63(16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52(13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e275(72.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u0026ndash;74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48(11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57(13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e329(77.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u0026ndash;79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90(17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93(18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94(18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e401(79.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80\u0026ndash;84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105(18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101(17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104(18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e446(78.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85\u0026ndash;89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e115(19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81(13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104(17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e467(77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95 or older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e412\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91(22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61(14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79(19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e301(73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull sample\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e558(17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e470(15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e533(17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2,403(76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e*There was a significant upward trend in the rate of diagnosis as patients aged (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003, chi-square test for trend).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e8. Rate of Diagnosis, Examination and Treatment of Osteoporosis by ERAS Adoption\u003c/p\u003e\n\u003cp\u003eAmong the 3,141 patients, 3,002 received surgical treatment. The rates of differences in diagnosis, examination, and treatment based on whether the patient adopted ERAS management mode during the perioperative period were compared and are presented in \u003cstrong\u003eTable\u0026nbsp;5\u003c/strong\u003e in a six-year investigation. The chi-square test for trend revealed a significant difference in the rates of diagnosis, the rates of BMD, the rates of BTMs and treatment between the ERAS group and the non-ERAS group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tabc\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eTable\u0026nbsp;5. Rate of Diagnosis, Examination and Treatment of Osteoporosis by ERAS Adoption\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull sample\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eERAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-ERAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatients studied, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiagnosed, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e508(16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e442(25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMD, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e459(15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e393(22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBTMs, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e512(17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e372(21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e140(10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreated, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,370(78.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,635(94.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e735(57.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e* There was a significant difference in the rates of diagnosis, BMD, BTMs and treatment between the ERAS group and the non-ERAS group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, chi-square test for trend).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe incidence of osteoporotic fractures has been increasing due to the progressive aging of the global population. According to estimates, the number of osteoporotic fractures in China is expected to rise to 4.83\u0026nbsp;million by 2035 and 5.99\u0026nbsp;million by 2050 \u003csup\u003e35\u003c/sup\u003e. If osteoporosis can be diagnosed promptly and accurately, and treated systematically and effectively, the risk of osteoporotic fractures will be greatly reduced \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e; \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e; \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. Therefore, this study aimed to assess the effectiveness of diagnosis, examination, and treatment of osteoporosis in elderly patients after hip fragility fractures. In the present study, hip fractures caused by low energy in individuals aged 60 and above were classified as osteoporotic fractures. This classification was based on two key factors. Firstly, the World Health Organization (WHO) designates individuals aged 60\u0026ndash;65 and above as elderly. Secondly, osteoporotic fractures are caused by low-energy trauma.\u003c/p\u003e \u003cp\u003eBy comparison of data grouped by year, it was observed that the diagnosis rate of osteoporosis has increased from 3.1% in 2017 to 65.2% in 2022, with the most significant increase observed in 2021 and 2022. Similar patterns were also observed in the rates of treatment. The treatment rate experienced a significant increase, which rose from 68.6% in 2017 to 93.5% in 2022. Another significant aspect of the current study was to investigate the potential of perioperative ERAS management in reduction of the misdiagnosis rate of osteoporosis. A comparative analysis revealed that the rate of diagnosis in the ERAS group (25.7%) was significantly higher compared to the non-ERAS group (5.2%). The overall diagnosis rate for the entire sample was found to be 16.9%. Therefore, this provides strong evidence for the reduction of misdiagnosis rates of osteoporosis in ERAS management during the perioperative period. Overall, the presented data indicate a progressive increase in the level of attention dedicated by medical personnel to the management of osteoporosis over the years.\u003c/p\u003e \u003cp\u003eThis study also revealed that 56.77% of patients with hip fragility fractures had abnormal elevations of serum CTX and/or PINP levels at admission. Particularly, isolated elevation of bone resorption marker (CTX) or combined elevations of both bone resorption (CTX) and formation markers (PINP) were prevalent. This indicates markedly increased bone turnover in this patient population, potentially accelerating bone loss and increasing osteoporosis risk, thereby elevating the likelihood of subsequent fractures \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Isolated elevation of CTX indicates excessive bone resorption activity, whereas concurrent elevation of both CTX and PINP indicates overall accelerated bone remodeling, where compensatory bone formation might still fail to prevent net bone loss \u003csup\u003e\u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Therefore, we recommend routine assessment of bone turnover markers upon admission to facilitate early identification and targeted osteoporosis intervention. Moreover, baseline CTX and PINP measurements at admission provide valuable reference points for monitoring therapeutic response and bone metabolism changes during follow-up \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite the relatively low diagnosis rate of osteoporosis, it is fortunate that the treatment rate for this condition is high. Patients who adhere to ERAS protocols show a significantly higher rate of treatment for osteoporosis. The authors\u0026rsquo; ward initiated the implementation of ERAS management in May 2016, which was later expanded to include all patients undergoing joint arthroplasty and those with hip fractures. Therefore, starting from 2017, the patients were divided into two groups: the ERAS group and the non-ERAS group, based on whether they adopted ERAS management during the perioperative period. Since 2022, our hospital has implemented ERAS management for all hip fracture patients, based on the positive outcomes associated with this approach. Consequently, the dataset for the non-ERAS group does not include data from the year 2022.\u003c/p\u003e \u003cp\u003eThere are limitations that should be noted in this study. This is a single-center retrospective study, which may introduce bias. In addition, only hip fractures were included in the analysis, while other major osteoporotic fractures, such as vertebral, proximal humerus, and distal radius fractures, were not considered in the assessment of osteoporosis diagnosis and treatment. However, there are multiple strengths to consider, which include a sample size of over 3,000 cases and the inclusion of a representative sample from a typical Chinese tertiary general hospital.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe diagnosis rate of osteoporosis in elderly individuals with hip fragility fractures is relatively low. However, the rate of treatment for this condition is significantly higher than the rate of diagnosis and shows gradual improvement over time. The frequency of bone mineral density testing is also relatively low. ERAS has the potential to improve the rates of diagnosis and treatment for osteoporosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe Medical Ethics Committee of The First Affiliated Hospital of Soochow University approved the study protocol and waived the need for patient informed consent owing to the retrospective nature of the study (Reference Number: (2023) Ethical Research Approval No. 188). The study was conducted in accordance with the principles of the Declaration of Helsinki of 1975 (as amended in 1983).\u003c/p\u003e\n\u003ch2\u003eConflict of Interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was funded by the Innovation Center Project of Orthopedic Surgery in Jiangsu Province (CXZX202209), the Special Project of Diagnosis and Treatment Technology for Key Clinical Diseases in Suzhou (LCZX202302 and LCZX202304) and the Key Project of \u0026ldquo;Strengthening Health through Science and Education\u0026rdquo; in Suzhou (ZDXM2024001).\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eConceptualization: Jun Zhou, Miao Chen, Wei Wang, Yan Lu; Data curation: Xu Zhang, Miao Chen, Xingzhou Wei, Quan Zhou, Xiaoyang Wu, Hanrong Xia; Formal Analysis: Yan Lu, Xingzhou Wei, Feng Zhu, Yijun Wang, Tong Jin; Writing-original draft: Miao Chen. Writing-review \u0026amp; editing: Jun Zhou, Yaozeng Xu, Lianfang Zhang. Supervision: Jun Zhou.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe thank Prof. Timothy E. Hewett of Department of Orthopaedic Surgery, Marshall University, Huntington, West Virginia, USA for his review and advices of this manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eTh datasets used and/or analyzed in the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCompston JE, McClung MR, Leslie WD. 2019. Osteoporosis. Lancet 393:364-376.\u003c/li\u003e\n\u003cli\u003eHansen DG, Tutaworn T, Lane JM. 2022. What\u0026apos;s New in Osteoporosis and Fragility Fractures. J Bone Joint Surg Am 104:1509-1515.\u003c/li\u003e\n\u003cli\u003eKanis JA. 1994. 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Osteoporos Int 26:513-519.\u003c/li\u003e\n\u003cli\u003eClarke BL. 2022. Economic Costs of Severe Osteoporotic Fractures Continue to Increase at Expense of Refracture. J Bone Miner Res 37:1809-1810.\u003c/li\u003e\n\u003cli\u003eFox KM, Magaziner J, Hawkes WG, et al. 2000. Loss of bone density and lean body mass after hip fracture. Osteoporos Int 11:31-35.\u003c/li\u003e\n\u003cli\u003eDirschl DR, Piedrahita L, Henderson RC. 2000. Bone mineral density 6 years after a hip fracture: a prospective, longitudinal study. Bone 26:95-98.\u003c/li\u003e\n\u003cli\u003eLonnroos E, Kautiainen H, Karppi P, et al. 2007. Incidence of second hip fractures. A population-based study. Osteoporos Int 18:1279-1285.\u003c/li\u003e\n\u003cli\u003eFollin SL, Black JN, McDermott MT. 2003. Lack of diagnosis and treatment of osteoporosis in men and women after hip fracture. Pharmacotherapy 23:190-198.\u003c/li\u003e\n\u003cli\u003eBlack DM, Cummings SR, Karpf DB, et al. 1996. 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Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review. J Clin Med 11.\u003c/li\u003e\n\u003cli\u003eChen P, Li Z, Hu Y. 2016. Prevalence of osteoporosis in China: a meta-analysis and systematic review. BMC Public Health 16:1039.\u003c/li\u003e\n\u003cli\u003eHarris ST, Watts NB, Genant HK, et al. 1999. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282:1344-1352.\u003c/li\u003e\n\u003cli\u003eKarpf DB, Shapiro DR, Seeman E, et al. 1997. Prevention of nonvertebral fractures by alendronate. A meta-analysis. Alendronate Osteoporosis Treatment Study Groups. JAMA 277:1159-1164.\u003c/li\u003e\n\u003cli\u003eSchini M, Vilaca T, Gossiel F, et al. 2023. Bone Turnover Markers: Basic Biology to Clinical Applications. Endocr Rev 44:417-473.\u003c/li\u003e\n\u003cli\u003eSzulc P, Delmas PD. 2008. Biochemical markers of bone turnover: potential use in the investigation and management of postmenopausal osteoporosis. Osteoporosis International 19:1683-1704.\u003c/li\u003e\n\u003cli\u003eSzulc P. 2018. Bone turnover: Biology and assessment tools. Best Pract Res Cl En 32:725-738.\u003c/li\u003e\n\u003cli\u003eLangdahl BL. 2018. Is There a Place for Bone Turnover Markers in the Management of Osteoporosis? Journal of Bone and Mineral Research 33:1197-1198.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hip fragility fracture, Osteoporosis, Diagnosis, Therapeutics, Fracture prevention, Enhanced recovery after surgery","lastPublishedDoi":"10.21203/rs.3.rs-6662537/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6662537/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eSummary: \u003c/strong\u003eTimely management of osteoporosis is vitally important for elderly patients with hip fragility fractures. Our study revealed age-related enhancements in diagnostic and therapeutic rates in this population, with notable improvements facilitated by enhanced recovery after surgery (ERAS) protocols. Heightening awareness among orthopedic surgeons regarding the importance of osteoporosis is necessary.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eThe implementation of standardized diagnostic and treatment protocols for osteoporosis in elderly patients with fractures has the potential to prevent subsequent fractures. This study aims to analyze the diagnosis and treatment of osteoporosis in elderly patients who have experienced hip fragility fractures over a six-year period at a single medical center. Additionally, this study assessed whether enhanced recovery after surgery (ERAS) protocols could ameliorate the diagnosis and treatment of osteoporosis in these patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe study included patients aged 60 years or older who suffered hip fractures and were hospitalized in a tertiary general hospital in China during the years 2017-2022. The database search yielded 3,141 patients, and a determination was made regarding the proportion of patients who received a diagnosis, examination, and treatment for osteoporosis following a fracture occurrence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Among these patients, 558 individuals (17.8%) were diagnosed with osteoporosis, 470 (15.0%) underwent bone mineral density scans, 532 (16.9%) had their bone turnover markers assessed, and 2,403 (76.5%) received treatment for osteoporosis. The outcomes showed significant improvement over the years as patients aged (p \u0026lt; 0.01). Meanwhile, among the 3,002 patients who underwent surgical treatment, the diagnosis and treatment rates of osteoporosis in patients managed by ERAS mode were significantly higher than those not managed by ERAS mode (p \u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Orthopedic surgeons often underestimate the importance of osteoporosis in elderly patients with hip fragility fractures, which could lead to missed opportunities for timely diagnosis and proper treatment. Perioperative ERAS management can reduce the missed diagnosis and treatment rates of osteoporosis.\u003c/p\u003e","manuscriptTitle":"Do orthopedic surgeons pay sufficient attention to osteoporosis in elderly patients with hip fragility fractures? A retrospective cohort study of a tertiary general hospital in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 19:29:56","doi":"10.21203/rs.3.rs-6662537/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"74b6b5b0-3d10-44f2-ae49-126bf51181da","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-25T08:58:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-18 19:29:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6662537","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6662537","identity":"rs-6662537","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}