Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort

Ethnic and racial minority patients are under-represented in US clinical trials for surgical management of hip fractures

INTRODUCTION

The impact of social determinants on clinical outcomes following surgeries for orthopaedic injuries are well-documented. In this study, we sought to quantify the representation of women, racial, and ethnic minorities in US-based clinical trials for hip fracture surgery.

METHODS

This was a cross-sectional analysis of patients enrolled in US-based, interventional clinical trials for hip fractures registered on ClinicalTrials.gov (2000-2022). Participation-to-prevalence ratios (PPRs) were calculated for demographic groups in clinical trials relative to their prevalence among patients receiving hip fracture surgery in the National Inpatient Sample (2006-2015). PPRs between 0.8-1.2 were considered equitable representation. PPRs<0.8 were considered underrepresentation and PPRs>1.2 were considered overrepresentation. Temporal trends were analyzed between previous (2000-2010) and contemporary (2011-2022) periods.

RESULTS

There were thirty-eight hip fracture clinical trials involving 6937 participants included in this study. All clinical trials reported sex, but only sixteen trials (42 %) reported race and ten trials (26 %) reported ethnicity. In total, trial participants were predominately White (89.3 %) and female (68.0 %). Few patients were non-White including Asian (7.2 %), Black (2.1 %), and Hispanic (0.8 %). Female (PPR=0.97) and male (PPR=1.07) patients had equitable representation. However, Hispanic (PPR=0.22), and African American (PPR=0.51) patients were underrepresented. White patients (PPR=1.00) had equitable representation while Asian patients were overrepresented (PPR=4.50). The rate of race (P < 0.001) and ethnicity (P = 0.010) reporting increased between previous and contemporary periods.

CONCLUSION

Recruitment of racial and ethnic minorities into hip fracture clinical trials remains limited. The impact of social determinants on outcomes after trauma surgery requires equitable representation of all groups in clinical trials to ensure translatability of results. Stakeholders across healthcare, industry, and government must work to address these disparities.

Medical Comorbidity and Male Sex Are Associated With Higher In-hospital Mortality for 90-Day Readmissions and Higher Readmission Rates After Nonelective Primary Total Hip Arthroplasty for Hip Fracture

PURPOSE

To assess whether sex and comorbidity are associated with the risk of 90-day readmission and associated mortality after nonelective primary total hip arthroplasty (THA) for hip fracture in the United States.

METHODS

We used the 2016-2019 US Nationwide Readmissions Database, a nationally representative dataset of readmissions, to examine 90-day readmission outcomes after primary nonelective THA with a primary diagnosis of hip fracture. Sex and medical comorbidity (Deyo-Charlson Comorbidity Index) were variables of interest. We adjusted for demographics (age), social determinants of health (income, region, insurance payer), and hospital characteristics (control, location/teaching status, bed size). We calculated adjusted odds ratio (aOR) and 95% confidence intervals (CIs) in multivariable-adjusted logistic regression analyses.

RESULTS

Of the 346,030 nonelective primary THAs for hip fracture performed in the United States, 61,443 (17.8%) had a 90-day readmission. For readmitted patients, the mean age was 80.2 years (SD, 9.6), 62.0% were women, and 90.6% had Medicare payer. In multivariable-adjusted analysis, compared with men, women had a lower aOR of 0.75 (95% CI, 0.73-0.77; p < 0.001) for 90-day readmission and lower aOR of 0.76 (95% CI, 0.69-0.84; p < 0.001) of in-hospital mortality during readmission, after nonelective primary THA for hip fracture. Deyo-Charlson index scores of 1 and ≥2 were associated with higher aOR of 90-day readmission at 1.53 (95% CI, 1.47-1.59; p < 0.001) and 2.20 (95% CI, 2.13-2.28; p < 0.001) and higher in-hospital mortality during readmission, 1.20 (95% CI, 1.01-1.42; p = 0.04) and 1.69 (95% CI, 1.40-1.97; p < 0.001), respectively.

CONCLUSION

In contemporary U.S. national data from 2016 to 2019, medical comorbidity and male sex were each associated with a higher risk of 90-day readmission and in-hospital mortality following primary nonelective THA for hip fracture. Further investigation into mechanisms and pathways of increased risk in men and those with higher medical comorbidity undergoing primary THA for hip fracture is needed, which can lead to the development of pathways for risk reduction and improved outcomes.

Related factors of postoperative half-year care utilization for health status and recovery in older adults with hip fracture: A retrospective study of Osaka National Health Insurance Data

AIM

The aim of this study was to investigate the relationship between preoperative patient factors and postoperative half-year health care utilization reflecting recovery, common complications, comorbidities, and significant health concerns, identifying strong risk and protective factors.

METHODS

This retrospective cohort study utilized linear, quantile, and ordinal regressions to analyze Osaka National Health Insurance data from 26 606 elderly patients who underwent hip fracture surgery between 2012 and 2018.

RESULTS

The key factors associated with multiple postoperative care utilizations (P < 0.001) included: 1 Compared with men, women were strongly negatively correlated with postoperative length of stay (LOS) at q90, diabetes prescriptions or drip injections, while showing strong positive associations with postoperative antihypertensive, antiosteoporosis, and antidementia prescriptions. 2 Age has a strong negative correlation with antiosteoporosis or diabetes prescriptions but strongly positive associations with indwelling urinary catheters or drip injections. 3 The preoperative 1-year LOS correlated positively with the postoperative LOS or indwelling urinary catheters, and the strongest associations were observed at q25 with the postoperative LOS. It was significantly and negatively associated with antihypertensive or antidementia prescriptions. 4 Many preoperative care utilizations were positive factors, and some were strong factors at q25 of the LOS.

CONCLUSIONS

Nuanced relationships between the female sex; preoperative LOS; antidementia, antiosteoporosis, antihypertensive and constipation prescriptions; indwelling catheters, and postoperative LOS were elucidated. These are key risks during shorter postoperative LOS, while male subgroups are at a higher risk during longer LOS duration. Patients with extended preoperative diabetes prescriptions or drip injections are at high risk of multiple postoperative care. Geriatr Gerontol Int 2025; 25: 190-205.

Associations of age and sex with characteristics of extracellular vesicles and protein-enriched fractions of blood plasma

Extracellular vesicles (EVs) are nanosized particles that are released by various cell types and play vital roles in intercellular communication. They carry biological molecules reflecting the physiological and pathological states of their source cells and tissues, showing potential as biomarkers. However, the impact of demographic factors like age and sex on the properties of blood plasma EVs remains underexplored. This study aims to fill this gap by evaluating how these factors influence the particle count and proteomic profiles of plasma EV preparations and corresponding protein fractions. Plasma samples from 120 healthy volunteers were collected and pooled into six groups: young males (age: 27.6 ± 4.0), young females (27.4 ± 3.8), middle-aged males (48.8 ± 3.8), middle-aged females (48.9 ± 3.9), old males (69.3 ± 3.9), and old females (69.4 ± 4.3). EV- and protein-enriched fractions were separated by size-exclusion chromatography (SEC). Fractions were characterized for particle number concentration and protein composition to identify characteristics affected by age and biological sex. Plasma EVs and corresponding protein fractions exhibited distinct characteristics, with differential enrichment of markers related to EVs and other blood components, including lipoproteins. Proteomic profiles of both EVs and protein fractions displayed sex- and age-dependent differences. Differentially abundant proteins displayed functions previously identified in the context of aging and sex differences, highlighting their utility as biomarkers. Age and sex significantly affect the characteristics of plasma EVs and proteins, potentially influencing their efficacy and interpretation as biomarkers in clinical applications. This study lays the groundwork for detailed mechanistic research to understand how EVs mediate age- and sex-related effects in health.

Return on investment of fracture liaison services: a systematic review and analysis

Fracture liaison services (FLS) have been proven clinically effective and cost-effective in preventing subsequent fractures among patients with an existing fragility fracture. Little is known about their monetary benefits such as their return on investment (ROI). This systematic review aimed to investigate the ROI of FLS and identify the FLS characteristics with better ROI. Studies on the cost-effectiveness of FLS published between January 2000 and December 2022 were searched from MEDLINE, EMBASE, PubMed, and Cochrane Central. Two independent reviewers conducted study selection and data extraction. ROI was calculated based on the difference between monetary benefits and FLS costs divided by the FLS costs. Subgroup analysis of ROI was performed across FLS types and FLS design details. A total of 23 FLS were included in this review. The majority of them were targeting patients aged over 50 years having fractures without identified sites. The mean ROI of these FLS was 10.49 (with a median ROI of 7.57), and 86.96% of FLS had positive ROI. FLS making treatment recommendations yielded the highest ROI (with a mean ROI of 18.39 and a median of 13.60). Incorporating primary care providers (with a mean ROI of 16.04 and a median of 13.20) or having them as program leaders (with a mean ROI of 12.07 and a median of 12.07) has demonstrated a high ROI. FLS for specific fracture sites had great monetary return. Intensive FLS such as type A and B FLS programs had higher ROI than non-intensive type C and D FLS. This review revealed a 10.49-fold monetary return of FLS. Identified characteristics contributing to greater economic return informed value-for-money FLS designs. Findings highlight the importance of FLS and the feasibility of expanding their contribution in mitigating the economic burden of osteoporotic fracture and are conducive to the promotion of FLS internationally.

Age-dependent gender differences in the diagnosis and treatment of osteoporosis during hospitalization in patients with fragility fractures

BACKGROUND

There is a gender difference in the acceptance of osteoporosis diagnosis and treatment in patients after fragility fractures, but this difference is rarely assessed during hospitalization, and it is unclear whether these differences are age-dependent. This study aimed to evaluate the differences between male and female fragility fracture patients of different age groups who received the diagnosis and treatment of osteoporosis during hospitalization.

METHODS

31,265 fragility fracture patients aged ≥ 50 years from the Fragility Fracture Management Database in a high-volume orthopedic hospital from December 2019 to February 2023 were included in this study. We compared the differences in the rates of men and women with fragility fracture who received the measurement of bone mineral density (BMD) and bone metabolism biochemical markers (BMBMs) and treatment with anti-osteoporosis medications (AOMs), and follow-up to the internal medicine clinic within 3 months after discharge, across all age groups and across different age stages (50-59, 60-69, 70-79, and ≥ 80 years).

RESULTS

The detection rates of female patients receiving BMD and BMBMs during hospitalization were 31.88% and 5.30%, respectively, compared with 22.23% and 2.69% for men. The rate of receiving any AOMs treatment was 44.63% for women and 31.60% for men. The follow-up rate of returning to the internal medicine clinic within 3 months after discharge was 9.79% for women compared to 3.00% for men. There was a significant difference between males compared to females (P < 0.0001). Analysis of patients by different age group revealed that differences in the diagnosis and treatment of osteoporosis were found only in patients under 80 years of age, while gender differences in the return to the internal medicine clinic for follow-up after discharge were present in all age groups.

CONCLUSIONS

Gender differences present in osteoporosis management in patients with fragility fracture during hospitalization, especially for patients under 80 years of age. This finding suggests that orthopedic surgeons neglect to manage osteoporosis in male patients with fragility fracture during hospitalization.