Impact of osteoporosis pharmacotherapy and vitamin d supplementation on fracture morphology and treatment of pelvic fragility fractures: a retrospective cohort study of 1493 patients from the German Pelvic Trauma Registry.

The majority of patients who sustained a fragility fracture of the pelvis were untreated for osteoporosis prior to fracture.

• Of 1493 patients, 1009 (67.6%) received no treatment (NOT) before FFP.
• Only 98 patients (6.6%) had specific osteoporosis medication (SOM) and 386 patients (25.9%) had vitamin D supplementation only (VitD) before FFP.
• The study population had a mean age of 82.34 ± 8.06 years and was predominantly female (83.5%).
• Data were drawn from the German Pelvic Fracture Registry covering 2018–2024, including patients ≥ 60 years with an FFP.

Patients receiving specific osteoporosis medication before fracture were significantly older, more often female, and had higher prefracture functional independence compared to other groups.

• The SOM group was significantly older and predominantly female (p < 0.05).
• Prefracture functional independence was 71.4% in the SOM group versus 58.5% in the VitD group and 66.4% in the NOT group (p = 0.018).
• Patients were grouped hierarchically as SOM, VitD, or NOT based on their treatment status before FFP.

Patients with prefracture specific osteoporosis medication treatment sustained more severe, unstable (FFP Type IV) fractures compared to untreated or vitamin D-only patients.

• FFP Type IV fractures occurred in 33.7% of the SOM group versus 23.3% in the VitD group and 19.8% in the NOT group (p = 0.006).
• FFP Type IV fractures represent the most unstable fracture morphology category in the classification used.
• The authors suggest this may reflect advanced disease severity or altered bone biomechanics from medication.

Patients with prefracture specific osteoporosis medication treatment underwent operative treatment more frequently than those in the VitD or no-treatment groups.

• Operative treatment was performed in 45.9% of the SOM group versus 30.4% of the VitD group and 29.2% of the NOT group (p = 0.006).
• The higher rate of surgical intervention corresponded with the higher proportion of unstable FFP Type IV fractures in the SOM group.

Secondary fracture prevention after a fragility fracture of the pelvis remained suboptimal, with one-third of patients receiving no change in osteoporosis treatment following the fracture.

• Following an FFP, in 527 patients (35.9%), the treatment regime was escalated.
• In 463 patients (31.0%), no change in treatment occurred after the fracture.
• One-third of patients did not receive any osteoporosis treatment even after sustaining an FFP, despite established treatment guidelines.