Phruetthiphat Ong-Art, Kanokwongnuwat Wasin, Satravaha Yodhathai, Pinijprapa Panukorn, Chaichankul Chaisiri, Gajaseni Pawin
Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
Faculty of dentistry, Mahidol university, Bangkok, Thailand.
Sci Rep. 2025 Jul 14;15(1):25417. doi: 10.1038/s41598-025-11387-y.
Fragility hip fractures in the elderly are associated with high mortality and a decline in functional outcome. Vertebral fractures are the most common osteoporotic fractures in the elderly population. Data is lacking on the association between hip fracture and osteoporotic vertebral compression fracture (OVCF), particularly regarding recovery and functional outcomes. This study aimed to compare functional outcomes and short-term recovery between patients with isolated hip fracture and those with coexisting hip fracture and OVCF and to identify the prevalence of combined hip fracture and OVCF. A prospective study of hip fractures undergoing surgery by the fracture liaison service (FLS) care team were reviewed. Patient demographics and radiological assessment with a minimal two-year follow up were recorded. The patients were divided into two groups: isolated hip fracture and hip fracture concurrent with OVCF. Physical performance was measured using time up and go test (TUG) at 2 and 6-weeks follow-up. Functional outcome was assessed by Harris hip score (HHS) at 6 months and 1 year. 81 patients were included. The mean age of the patients was 78.70 years, with a male-to-female ratio of 3:7. 25 patients (30.9%) were isolated hip fracture and 56 patients (69.1%) were combined with OVCF. 46 individuals were Genant grades 1-2 and 10 individuals were Genant grade 3. Hip T-score and spine BMD in the combined group were significantly lower than the isolated group (0.64 vs. 0.70 g/cm2, p = 0.03; -1.68 vs. -0.84, p = 0.033, respectively). The 6-week TUG test was significantly lower in the isolated group (p = 0.042). The 6-month and one-year HHS were significantly higher in the isolated group compared to the combined group (82.5 vs. 77.5, p = 0.007; 87.4 vs. 80.8, p = 0.005, respectively). At the 6-month follow-up, 46 patients with mild to moderate OVCF (Genant grades 1-2) and 10 severe OVCF (Genant grade 3) demonstrated significantly lower HHS compared to those with no OVCF (grade 0) (78.0 vs. 82.5, p = 0.014; and 74.5 vs. 82.5, p = 0.012, respectively). However, there were no significant difference of HHS at one-year among the 3 groups (p = 0.056). The mean length of hospital stay was significantly shorter in the isolated group (7 days vs. 11 days; p = 0.022). A significant portion of elderly hip fractures occurred with coexisting OVCF. This combined group experienced slower functional recovery, longer hospital stays, and worse long-term outcomes compared to those with isolated hip fractures. Notably, the severity of OVCF was directly linked to poorer outcomes, highlighting the need for more attention and tailored rehabilitation programs for these patients.
老年人髋部脆性骨折与高死亡率及功能预后下降相关。椎体骨折是老年人群中最常见的骨质疏松性骨折。目前缺乏关于髋部骨折与骨质疏松性椎体压缩骨折（OVCF）之间关联的数据，尤其是在恢复情况和功能预后方面。本研究旨在比较单纯髋部骨折患者与合并髋部骨折和OVCF患者的功能预后及短期恢复情况，并确定髋部骨折合并OVCF的患病率。对骨折联络服务（FLS）护理团队进行手术的髋部骨折患者进行了一项前瞻性研究。记录了患者的人口统计学数据以及至少两年的放射学评估情况。患者被分为两组：单纯髋部骨折组和合并OVCF的髋部骨折组。在随访2周和6周时，使用计时起立行走测试（TUG）测量身体表现。在6个月和1年时，通过Harris髋关节评分（HHS）评估功能预后。共纳入81例患者。患者的平均年龄为78.70岁，男女比例为3:7。25例患者（30.9%）为单纯髋部骨折，56例患者（69.1%）合并OVCF。46例个体为Genant 1 - 2级，10例个体为Genant 3级。合并组的髋部T值和脊柱骨密度显著低于单纯组（分别为0.64 vs. 0.70 g/cm²，p = 0.03；-1.68 vs. -0.84，p = 0.033）。单纯组的6周TUG测试结果显著更低（p = 0.042）。与合并组相比，单纯组在6个月和1年时的HHS显著更高（分别为82.5 vs. 77.5，p = 0.007；87.4 vs. 80.8，p = 0.005）。在6个月随访时，46例轻度至中度OVCF（Genant 1 - 2级）和10例重度OVCF（Genant 3级）患者的HHS显著低于无OVCF（0级）患者（分别为78.0 vs. 82.5，p = 0.014；74.5 vs. 82.5，p = 0.012）。然而，三组在1年时的HHS无显著差异（p = 0.056）。单纯组的平均住院时间显著更短（7天 vs. 11天；p = 0.022）。相当一部分老年髋部骨折伴有OVCF。与单纯髋部骨折患者相比，这个合并组的功能恢复较慢、住院时间更长且长期预后更差。值得注意的是，OVCF的严重程度与更差的预后直接相关，这凸显了对这些患者需要给予更多关注并制定针对性康复计划。
