Variation in Osteoporosis Treatment Gaps Across Fracture-Related and Elective Orthopedic Surgeries: A Single-Center Retrospective Cohort Study in Taiwan
5 affiliations
- 1Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- 2Department of Nursing, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- 3Department of Post-Baccalaureate Medicine, College of Medicine, National Chung-Hsing University, Taichung 402202, Taiwan
- 4Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- 5School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan
Abstract
Background/Objectives: Fracture liaison services (FLSs) typically use fragility fractures as triggers to identify patients for osteoporosis care. Patients undergoing elective orthopedic surgery who already have osteoporosis documented on a preoperative densitometry report fall outside this trigger. This study compared recorded initiation of osteoporosis treatment after elective operations with that after operations performed for a fracture. A secondary, exploratory objective was to describe how preoperative T-score relates to subsequent fractures in patients without recorded treatment. Methods: A retrospective cohort study (2015–2025) was performed at a tertiary center in Taiwan. The source population was the institutional densitometry cohort (all patients with at least one DXA examination at the hospital), within which five index operations were identified: vertebroplasty/kyphoplasty, hip fracture internal fixation, hip arthroplasty (hemi- or total), lumbar spinal fusion, and total knee arthroplasty. Operations in patients already receiving osteoporosis therapy were excluded. The primary outcome was recorded initiation of anti-osteoporosis therapy, defined as the first dispensing at the study hospital within 365 days of surgery. Odds ratios were estimated by logistic regression with patient-clustered standard errors. Results: Among 6171 operations in 5739 patients, recorded one-year initiation was 28.4% overall: 46.9% after vertebroplasty, 43.1% after hip fracture fixation, 33.0% after hip arthroplasty, 17.4% after lumbar fusion, and 7.2% after total knee arthroplasty. Adjusted odds ratios versus fusion ranged from 3.16 (95% CI: 2.69–3.72) for vertebroplasty to 0.28 (0.21–0.37) for knee arthroplasty. Within hip arthroplasty, initiation was 43.9% after hemiarthroplasty, which is performed for femoral neck fracture, and 6.7% after total hip arthroplasty. Across all operations, an accompanying fracture diagnosis was associated with initiation (adjusted OR: 6.19, 5.26–7.29). The contrast persisted among the 871 operations with osteoporosis documented before surgery (48.2% after vertebroplasty, 7.5% after knee arthroplasty). In the exploratory analysis of 1971 operations without recorded treatment (99 fractures), each one-unit lower T-score was associated with a higher hazard of major osteoporotic fracture (adjusted HR: 1.25, 1.04–1.49). The estimate for the T ≤ −2.5 dichotomy was less precise (HR: 1.33, 0.83–2.12). Conclusions: In this selected single-center densitometry cohort, preliminary findings indicate that recorded initiation of osteoporosis treatment after orthopedic surgery followed whether the operation was performed for a fracture rather than the patient’s documented bone density, including among patients whose osteoporosis was already documented. A national reimbursement rule that requires a fracture in addition to low bone density probably contributes. Treatment outside the study hospital was not captured, so initiation proportions are lower bounds. Whether an FLS entry point keyed to existing densitometry results would close this gap remains to be tested.
Related
- Comparative evaluation of sciatic obturator femoral nerve block technique versus central neuraxial blockade for anesthesia and post-operative analgesia for below knee orthopedic trauma surgeries.
- MAJOR ORTHOPEDIC SURGERIES CONDUCTED UNDER FITUSIRAN PROPHYLAXIS IN PEOPLE WITH HEMOPHILIA A AND B, WITH AND WITHOUT INHIBITORS
- Evaluation of treatment preferences among orthopedic surgeons and physical medicine and rehabilitation specialists for lateral epicondylitis : A cross-sectional survey study
- Application of orthopedic robotics in cancer surgery: integrating precision treatment and postoperative exercise rehabilitation
- Association of surgical risk prediction models with days alive out of hospital at 30 days in colorectal surgeries: a retrospective cohort study.
BibTeX
@article{hsu2026variation,
title = {{Variation in Osteoporosis Treatment Gaps Across Fracture-Related and Elective Orthopedic Surgeries: A Single-Center Retrospective Cohort Study in Taiwan}},
author = {Yuan-Sheng Hsu and Ya-Lian Deng and Sheng-Chieh Tseng and Cheng-Hung Lee and Kun-Hui Chen and Shih-Yi Lin},
journal = {Journal of clinical medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15197683},
url = {https://europepmc.org/article/PMC/PMC13666248},
note = {CC BY},
}
RIS
TY - JOUR
TI - Variation in Osteoporosis Treatment Gaps Across Fracture-Related and Elective Orthopedic Surgeries: A Single-Center Retrospective Cohort Study in Taiwan
AU - Yuan-Sheng Hsu
AU - Ya-Lian Deng
AU - Sheng-Chieh Tseng
AU - Cheng-Hung Lee
AU - Kun-Hui Chen
AU - Shih-Yi Lin
PY - 2026
DA - 2026/10/01
JO - Journal of clinical medicine
DO - 10.3390/jcm15197683
UR - https://europepmc.org/article/PMC/PMC13666248
AB - Background/Objectives: Fracture liaison services (FLSs) typically use fragility fractures as triggers to identify patients for osteoporosis care. Patients undergoing elective orthopedic surgery who already have osteoporosis documented on a preoperative densitometry report fall outside this trigger. This study compared recorded initiation of osteoporosis treatment after elective operations with that after operations performed for a fracture. A secondary, exploratory objective was to describe how preoperative T-score relates to subsequent fractures in patients without recorded treatment. Methods: A retrospective cohort study (2015–2025) was performed at a tertiary center in Taiwan. The source population was the institutional densitometry cohort (all patients with at least one DXA examination at the hospital), within which five index operations were identified: vertebroplasty/kyphoplasty, hip fracture internal fixation, hip arthroplasty (hemi- or total), lumbar spinal fusion, and total knee arthroplasty. Operations in patients already receiving osteoporosis therapy were excluded. The primary outcome was recorded initiation of anti-osteoporosis therapy, defined as the first dispensing at the study hospital within 365 days of surgery. Odds ratios were estimated by logistic regression with patient-clustered standard errors. Results: Among 6171 operations in 5739 patients, recorded one-year initiation was 28.4% overall: 46.9% after vertebroplasty, 43.1% after hip fracture fixation, 33.0% after hip arthroplasty, 17.4% after lumbar fusion, and 7.2% after total knee arthroplasty. Adjusted odds ratios versus fusion ranged from 3.16 (95% CI: 2.69–3.72) for vertebroplasty to 0.28 (0.21–0.37) for knee arthroplasty. Within hip arthroplasty, initiation was 43.9% after hemiarthroplasty, which is performed for femoral neck fracture, and 6.7% after total hip arthroplasty. Across all operations, an accompanying fracture diagnosis was associated with initiation (adjusted OR: 6.19, 5.26–7.29). The contrast persisted among the 871 operations with osteoporosis documented before surgery (48.2% after vertebroplasty, 7.5% after knee arthroplasty). In the exploratory analysis of 1971 operations without recorded treatment (99 fractures), each one-unit lower T-score was associated with a higher hazard of major osteoporotic fracture (adjusted HR: 1.25, 1.04–1.49). The estimate for the T ≤ −2.5 dichotomy was less precise (HR: 1.33, 0.83–2.12). Conclusions: In this selected single-center densitometry cohort, preliminary findings indicate that recorded initiation of osteoporosis treatment after orthopedic surgery followed whether the operation was performed for a fracture rather than the patient’s documented bone density, including among patients whose osteoporosis was already documented. A national reimbursement rule that requires a fracture in addition to low bone density probably contributes. Treatment outside the study hospital was not captured, so initiation proportions are lower bounds. Whether an FLS entry point keyed to existing densitometry results would close this gap remains to be tested.
SN - 2077-0383
ER -