Variation in Osteoporosis Treatment Gaps Across Fracture-Related and Elective Orthopedic Surgeries: A Single-Center Retrospective Cohort Study in Taiwan

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.