Arch Osteoporos. 2026 Mar 16;21(1):52. doi: 10.1007/s11657-026-01687-9.
ABSTRACT
Osteoporosis causes bone fragility and fractures, yet most patients receive no treatment. This German registry study of nearly 1500 elderly pelvic fracture patients found that two-thirds were untreated before fracture. Paradoxically, treated patients sustained more severe, displaced fractures requiring surgery more often, possibly reflecting advanced disease severity or altered bone properties from medication.
BACKGROUND: Fragility fractures of the pelvis (FFP) are related to low-energy trauma and osteoporosis. Currently, data on secondary pharmacological fracture prevention and their effect on fracture morphology is rare. We aimed to determine the proportion of patients receiving specific osteoporosis medication (SOM), vitamin D supplementation only (VitD), or no treatment (NOT) before and after a FFP. Secondarily, we evaluated possible differences in fracture morphology and treatment in the study population.
METHODS: This retrospective cohort study analyzed data from the German Pelvic Fracture Registry (2018-2024) of patients ≥ 60 years with an FFP. Patients were grouped hierarchically in the following groups: SOM, VitD, or NOT. Demographics, fracture morphology, treatment, and postfracture group changes regarding osteoporosis treatment were compared between groups.
RESULTS: Of 1493 patients, mean age 82.34 ± 8.06 years, predominantly female (83.5%), 98 (6.6%) had a SOM, 386 (25.9%) VitD, and 1009 (67.6%) NOT before FFP. The SOM group was significantly older, predominantly female (p < 0.05), and demonstrated higher prefracture functional independence (71.4% SOM vs. 58.5% VitD vs. 66.4% NOT; p = 0.018). FFP Type IV fractures occurred more frequently in the SOM group (33.7% SOM vs. 23.3% VitD, 19.8% NOT; p = 0.006) and were more frequently operatively treated (45.9% SOM vs. 30.4% VitD, 29.2% NOT; p = 0.006). Following a FFP, in 527 patients (35.9%), the treatment regime was escalated; in 463 patients (31.0%), no change occurred.
CONCLUSIONS: Despite established treatment guidelines, two-thirds of patients who sustained an FFP received neither SOM nor VitD in Germany. Patients with prefracture SOM treatment sustained more unstable fractures requiring surgical intervention, possibly reflecting advanced disease severity or altered bone biomechanics. Secondary fracture prevention remains suboptimal, with one-third of patients not receiving treatment postfracture.
PMID:41840122 | PMC:PMC12992445 | DOI:10.1007/s11657-026-01687-9