Cureus · Sep 25, 2026

Management, Practice, and Outcomes of Fragility Fractures and Osteoporosis Care at a Tertiary Hospital in Riyadh, Saudi Arabia

By Alsulaiman Y, Alsahli A, Alamoudi A et al.

Introduction and objectives Fragility fractures are sentinel events for osteoporosis, yet secondary prevention remains underused, and chronological age alone may not capture the physiological vulnerability that shapes post-fracture outcomes. The objective of this study is to evaluate osteoporosis-related care after fragility fracture and its association with frailty in adults hospitalized with fragility fractures in Riyadh, Saudi Arabia. Methods In this retrospective cohort study, electronic health records (EHRs) were reviewed for 301 adults admitted with fragility fractures at a tertiary hospital in Riyadh in 2024 (mean (SD) age, 72.8 (11.2) years; 52.2% women). Frailty was quantified using a cumulative deficit index built from 24 clinical, functional, and laboratory variables and categorized into quartile-based groups. Primary outcomes were prolonged hospitalization (>20 days) and mortality; secondary outcomes were unplanned readmission and refracture within one year. Results Anti-osteoporosis therapy was initiated during hospitalization in 8/301 patients (2.7%) and prescribed at discharge to 12/301 patients (4.0%); only 29 patients (9.6%) underwent follow-up bone mineral density (BMD) testing within one year. Out of 301 patients, 99 (32.9%) were classified as fit (frailty index (FI) ≤0.174), 63 (20.9%) as mildly frail, 67 (22.3%) as moderately frail, and 72 (23.9%) as severely frail. Compared with fit patients, patients with severe frailty had higher one-year mortality (19/72 (26.4%) vs 6/99 (6.1%); adjusted OR, 12.08; 95% CI, 1.54-94.89) and more prolonged hospitalizations (>20 days) (22/70 (31.4%) vs 2/90 (2.2%); adjusted OR, 6.38; 95% CI, 1.39-29.23). Associations with readmission and refracture were not statistically significant. Conclusion Osteoporosis care after fragility fracture was markedly underused, while a cumulative deficit FI identified patients at substantially higher risk of adverse outcomes. Routine frailty screening after fracture could help target secondary prevention efforts.

doi.org/10.7759/cureus.116907 Open access PubMed 42928876 Biomarkers