Risk of Subsequent Hip Fractures across Varying Treatment Patterns for Index Vertebral Compression Fractures

Introduction: Vertebral compression fractures (VCFs) pose a considerable healthcare burden and are linked to elevated morbidity and mortality. Despite available anti-osteoporotic treatments (AOTs), guideline adherence is lacking. This study aims to evaluate subsequent hip fracture incidence after index VCF and to elucidate AOT prescribing patterns in VCF patients, further assessing the impact of surgical interventions on these patterns. Materials and Methods: Patients with index VCFs between 2010 and 2021 were identified using the PearlDiver database. Diagnostic and procedural data were recorded using International Classification of Diseases (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes. Patients under age 50 and follow-up <one year following index VCF were excluded. Patients were categorized based on whether they received AOT within one year, preceding and after index VCF, and were subsequently propensity-matched 1:3 based on age, sex, and Elixhauser Comorbidity Index (ECI) score to compare hip fracture incidence following index VCF. Sub-analysis was performed for operatively managed VCFs (kyphoplasty/vertebroplasty). Statistical tests included Chi-squared for categorical outcomes, and Kruskal-Wallis for continuous measures. Results: Of 637,701 patients, 72.6% were female. The overall subsequent hip fracture incidence was 2.6% at one year and 12.9% for all-time follow-up. Propensity-matched analysis indicated higher subsequent hip fracture rates in patients initiated on AOT post-index VCF (one year: 3.8% vs. 3.5%, p = 0.0013; all-time: 14.3% vs. 13.0%, p < 0.0001). Conclusions: The study reveals an unexpected increase in subsequent hip fractures among patients initiated on AOT post-index VCF, likely due to selection bias. These findings highlight the need for refined osteoporosis-management strategies to improve guideline adherence, thereby mitigating patient morbidity and mortality.