Adherence to anti-osteoporotic therapy and five-year survival after fragility hip fracture: prognostic value of the MADiT stratification tool within a fracture liaison service.

In older adults with hip fractures followed in a Fracture Liaison Service, five-year survival was low, but adherence to osteoporosis medication among survivors was high (74.3% with ≥ 80% of doses). The MADiT tool stratified five-year mortality risk and may support treatment decisions in risk-based fracture care. PURPOSE: Fragility hip fractures in older adults are associated with high mortality and suboptimal long-term adherence to anti-osteoporotic therapy. This study assessed five-year adherence, survival, and the prognostic performance of the Diagnostic and Therapeutic Assignment Model (MADiT) stratification model in patients managed within a Fracture Liaison Service (FLS).

methodsWe conducted a prospective observational cohort study in an orthogeriatric unit integrated within an FLS. Consecutive patients aged ≥ 70 years admitted with fragility hip fractures between 2016 and 2017 were enrolled and followed for five years after discharge. Demographic, functional, cognitive and clinical variables were systematically collected. Adherence to anti-osteoporotic therapy was defined as receiving ≥ 80% of prescribed doses during follow-up and was assessed among five-year survivors using FLS and outpatient records. Five-year survival was analysed using Kaplan-Meier methods, and associations with mortality were explored using univariable Cox regression. Prognostic stratification was evaluated with the MADiT model.

resultsA total of 119 patients were included (mean age 87.2 ± 7.3 years; 77.3% women). Five-year survival was 29.4%. Among five-year survivors, 74.3% met the predefined adherence threshold. In univariable analyses, higher age, poorer baseline functional and cognitive status, in-hospital delirium, and a greater number of complications were associated with increased five-year mortality. MADiT showed good discriminative ability for five-year mortality (area under the curve 0.806), with a clear stepwise increase in mortality risk from the Green to the Red category.

conclusionIn this older cohort with fragility hip fractures managed through an FLS, long-term survival was low, whereas adherence to anti-osteoporotic therapy among survivors was relatively high. The MADiT stratification tool provided useful prognostic information for five-year mortality and may assist in early risk-based treatment decisions in multidisciplinary fracture care pathways.