Document Type

Conference Proceeding

Publication Date


Publication Title

Journal of Neurosurgery. Spine



Femoral neck (FNF) and vertebral compression fractures (VCF) are common fragility fractures (FF) in the elderly population. Defined as fractures from low-energy trauma, FF are diagnostic of osteoporosis and require treatment. The purpose of this study was to assess whether patients were appropriately diagnosed and treated for osteoporosis following fragility FNF and VCF.


A retrospective chart review was performed at a single-institution from 1/1/2017 to 12/31/2020 on consecutive patients who sustained fragility FNF treated with closed reduction percutaneous pinning, hemiarthroplasty, or total hip arthroplasty or VCF treated with kyphoplasty. Patients <50 years of age, who sustained a high-energy or a non-osteoporotic pathologic fracture, were treated non-operatively, or deceased within one-year post-op were excluded. Preoperative demographics, ASA, CCI, smoking, alcohol, and glucocorticoid use were obtained. Diagnosis and treatment of osteoporosis, including dual-energy X-ray absorptiometry (DEXA) scans, calcium, vitamin D, bisphosphonates, denosumab, and alternative treatments (teriparatide, calcitonin, raloxifene, estrogen) were assessed pre-op and within one-year post-op. Subsequent FF were recorded.


Of 593 patients, 276 FNF and 94 VCF were included. There was a difference in age (81.0 ± 10.8 FNF vs 76.7 ± 11.6 VCF) and BMI (23.9 ± 4.4 FNF vs 26.5 ± 4.9 VCF) between groups (p < 0.05). There was no difference in ASA, CCI, smoking, or alcohol use between groups (p > 0.05). There was no difference in pre-op osteoporosis diagnosis (19.2% FNF vs 28.7% VCF), DEXA scan usage, bisphosphonate, denosumab, alternative treatments, or prior fractures between groups (p > 0.05). Preoperatively, VCF patients had increased administration of concomitant vitamin D/calcium and glucocorticoids (p < 0.05). Postoperatively, there was no difference in new osteoporosis diagnosis (4% FNF vs 2.1% VCF), concomitant vitamin D/calcium, bisphosphonates, alternative treatments, glucocorticoid usage, or subsequent fractures between groups (p > 0.05). Postoperatively, VCF patients underwent more DEXA scans and treatment with denosumab (p < 0.05). In total, 12.7% of patients (10.5% FNF vs 19.1% VCF) received appropriate post-op osteoporosis treatment.


This study demonstrates that patients sustaining fragility FNF and VCF are underdiagnosed and undertreated for osteoporosis. Thus, heightened physician awareness to diagnose and treat osteoporosis following fragility fractures is necessary.





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Lumbar Spine Research Society 16th Annual Scientific Meeting, May 11-12, 2023, Chicago, IL