Osteoporosis and perioperative medical management of hip fracture

Purpose of review: The perioperative care of patients sustaining hip fractures is particularly challenging because of the patients' advanced age and multiple comorbidities. The objective of this article is to provide the orthopedist and the consulting medical physician an update of the literature on clinically relevant topics related to perioperative medical management and osteoporosis care in hip fracture patients. Recent findings: The following issues have recently been addressed in the literature: surgical timing, postoperative complications, venous thromboembolism prophylaxis, pain, and osteoporosis care. Over the past year, evidence suggests that (1) surgical delays up to 72 hours do not affect long-term mortality; (2) anticipating postoperative pulmonary complications is important; (3) adequate perioperative pain control helps improve long-term mobility; (4) treatment with vitamin D may prevent falls by improving muscle function; (5) the factor Xa inhibitors may improve venous thromboembolism prevention; and (6) clinical pathways for treatment of osteoporosis after hip fracture may improve osteoporosis treatment rates. Summary: This update has several clinical implications, including providing evidence that longer surgical delays do not worsen outcomes and emphasizing the importance of measures to reduce pulmonary complications. In addition, the prevention of venous thromboembolism may be improved by using the new factor Xa inhibitors. Educating the patient about osteoporosis is the first step in initiation of osteoporosis management, and consultation for evaluation is recommended. Research is needed in the development of evidence-based guidelines for preoperative medical evaluation, defining optimal duration of venous thromboembolism prophylaxis, and developing multidisciplinary treatment protocols to prevent recurrent fractures.