TOPLINE:

The integration of a dedicated nurse practitioner (NP) into the orthopedic inpatient workflow was associated with a sustained increase in osteoporosis documentation following hip fractures.

METHODOLOGY:

• Researchers conducted a retrospective cohort study of 6933 patients aged 60 years or older (mean age, 81.3 years; 63.5% women; median BMI, 24.6) who were hospitalized following a hip fracture between 2007 and 2024.
• The primary outcome was the change in osteoporosis documentation rates following hip fractures, particularly in relation to the integration of a dedicated NP into the orthopedic inpatient workflow in 2014.
• Secondary exploratory analyses examined associations between the documented diagnosis of osteoporosis and long-term outcomes, including all-cause mortality, subsequent fractures, and rehospitalizations.

TAKEAWAY:

• A total of 4150 patients (59.8%) were discharged with a diagnosis of osteoporosis or osteoporotic fracture, with a sustained increase in documentation rates observed after 2015 coinciding with the integration of an NP.
• Subsequent fractures occurred in 740 of 2783 patients (26.6%) without a documented diagnosis of osteoporosis and in 974 of 4150 patients (23.5%) with a documented diagnosis (P = .003). Between 2016 and 2024, patients with a documented diagnosis of osteoporosis (72%) were older (mean age, 82.3 vs 78.4 years; P < .001) than those without a documented diagnosis (28%).
• Patients without a documented diagnosis were more often discharged home (38.3% vs 27.2%), whereas those with a documented diagnosis were more frequently discharged to a senior care facility (30.2% vs 25.3%) or transferred to another ward in the same hospital (35.4% vs 28.4%; P < .001).
• In an exploratory multivariable analysis restricted to 1412 patients with complete covariate data from 2022 to 2024, documented osteoporosis was associated with lower mortality (adjusted hazard ratio, 0.63; P = .001).

IN PRACTICE:

“This focused, resource-efficient model may serve as a feasible alternative to comprehensive FLS [fracture liaison services] in hospitals with limited infrastructure, facilitating systematic recognition and documentation of osteoporosis risk in patients hospitalized with hip fracture,” the authors wrote.

SOURCE:

This study was led by Yehudit Eden-Friedman, Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel. It was published online on March 23, 2026, in BMC Musculoskeletal Disorders.

LIMITATIONS:

Incomplete capture of outpatient prescriptions and adherence limited the interpretation of treatment rates, and data on bone mineral density were largely missing. Clinical or radiographic vertebral fractures that did not require hospitalization were not captured, and hip fractures were recorded only on readmission to the study center, likely underestimating absolute fracture rates. Missing comorbidity data prevented the exclusion of residual confounding in mortality analyses, and as a single‑center retrospective electronic medical record-based study, residual confounding and incomplete system capture could not be excluded.

DISCLOSURES:

No funding was provided for this study. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.