What’s New in Osteoporosis and Fragility Fractures 2025

New insights regarding osteoporosis and fragility fractures are presented in the JBJS Guest Editorial What’s New in Osteoporosis and Fragility Fractures. Here, we highlight the 5 most notable studies, as selected by coauthor Cecilia Rogmark, MD, PhD.

Treatment for Hip Fractures

A study published in JBJS discussed the role of the orthopaedic surgeon in advanced care planning. The study highlighted an opportunity to optimize patient care, as patients are often seen by orthopaedic surgeons during sentinel events (e.g., fragility hip fractures) that signal a decline in overall health¹. “If the orthopaedic surgeon is able to provide advanced care planning together with the patient, family, and other involved physicians,” write Guest Editorial authors Drs. Rogmark and Frihagen, “individualized care respecting the life goals of the patient is obtained.”

DNA methylation age was associated with 1-year mortality following geriatric hip fracture in a pilot study published in JBJS. Bone- vs. blood-derived DNA methylation clocks were compared in 12 patients with hip fractures and found to be correlated. The study authors concluded that preventing advanced DNA methylation may help to reduce mortality following a hip fracture².

Treatment for Upper-Extremity Fractures

JBJS published the 5-year results of a level I randomized controlled trial (RCT) comparing reverse total shoulder arthroplasty (RTSA) vs. open reduction and internal fixation (ORIF) in elderly patients with displaced AO/OTA type-B2 and C2 proximal humeral fractures. The RTSA group had superior outcomes, with a 13.4-point higher Constant score (p = 0.002) and fewer adverse events than the ORIF group³.

The outcomes of nonoperative vs. operative treatment for displaced olecranon fractures in 64 elderly patients were reported in a level I RCT published in JBJS. The 12-month Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, the primary outcome, did not significantly differ between the groups⁴. However, “the 95% confidence interval included a clinically relevant difference in the DASH score favoring operative treatment”, note Drs. Rogmark and Frihagen.

Secondary Fracture Prevention and Osteoporosis Drugs

The effectiveness of a Fracture Liaison Service (FLS) in reducing secondary fracture rates and associated mortality was assessed in a study of 100,000 patients across 7 orthopaedic departments. Patients with a fracture (except in the fingers, toes, and skull) and an age of ≥50 years were eligible. The intervention included anti-osteoporosis drugs, fall prevention, and lifestyle advice. The FLS was associated with a decreased risk of subsequent fragility fracture and mortality at a maximum follow-up of 4.7 years⁵.

What’s New in Osteoporosis and Fragility Fractures is freely available at JBJS.org.

What’s New by Subspecialty

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org.

Recent OrthoBuzz posts include: What’s New in Limb Lengthening and Deformity Correction, What’s New in Orthopaedic Trauma, and What’s New in Spine Surgery.

Image reproduced from: Fraser AN, Wagle TM, Karlberg AC, Madsen JE, Mellberg M, Lian T, Mader S, Eilertsen L, Apold H, Larsen LB, Pripp AH, Fjalestad T. Reverse shoulder arthroplasty is superior to plate fixation for displaced proximal humeral fractures in the elderly: five-year follow-up of the DelPhi randomized controlled trial. J Bone Joint Surg Am. 2024 Nov 6;106(21):1945-56.

References

1. Segal KR, Piana LE, Mujahid N, Mikolasko B, Kuris EO, Daniels AH, Katarincic JA. Advanced care planning for the orthopaedic patient. J Bone Joint Surg Am. 2025 Jan 15;107(2):209-16.
2. Tarpada SP, Heid J, Sun S, Lee M, Maslov A, Vijg J, Sen M. Blood and bone-derived DNA methylation ages predict mortality after geriatric hip fracture: a pilot study. J Bone Joint Surg Am. 2025 Feb 19;107(4):381-8.
3. Fraser AN, Wagle TM, Karlberg AC, Madsen JE, Mellberg M, Lian T, Mader S, Eilertsen L, Apold H, Larsen LB, Pripp AH, Fjalestad T. Reverse shoulder arthroplasty is superior to plate fixation for displaced proximal humeral fractures in the elderly: five-year follow-up of the DelPhi randomized controlled trial. J Bone Joint Surg Am. 2024 Nov 6;106(21):1945-56.
4. Joshi MA, Le M, Campbell R, Sivakumar B, Limbers J, Harris IA, Symes M. Surgery for olecranon fractures in the elderly (SOFIE): results of the SOFIE randomized controlled trial. J Bone Joint Surg Am. 2025 Mar 5;107(5):452-8.
5. Andreasen C, Dahl C, Frihagen F, Borgen TT, Basso T, Gjertsen JE, Figved W, Wisløff T, Hagen G, Apalset EM, Stutzer JM, Lund I, Hansen AK, Nissen FI, Joakimsen RM, Syversen U, Eriksen EF, Nordsletten L, Omsland TK, Bjørnerem Å, Solberg LB. Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian Capture the Fracture Initiative). Osteoporos Int. 2025 Mar;36(3):501-12.