The objective of our study is to determine the prevalence of malnutrition in elderly patients with fragility hip fractures through different diagnostic tools and to determine which nutritional assessment tool better predicts mortality. Methods: This is a prospective study in patients over 65 years of age hospitalized with a diagnosis of hip fracture. A nutritional assessment was performed using several tools: the Mini Nutritional Assessment Short Form (MNA-SF), the Subjective Global Assessment (SGA), and the GLIM criteria. For the definition of low muscle mass, four different methods were used: hand grip strength (HGS), calf circumference (CC), anthropometry, and bioelectrical impedance (BIA). Mortality was registered at three, six and twelve months. Results: 300 patients were included, 79.3% female, mean age 82.9 ± 7.1 years. The MNA-SF found 42% at risk of malnutrition, and 37.3% malnourished. Using SGA, there were 44% with moderate malnutrition, and 21.7% with severe malnutrition. In application of the GLIM criteria, 84.3%, 47%, 46%, and 72.7% of patients were malnourished when HGS, anthropometry, BIA, and CC were used, respectively. Mortality was 10%, 16.3% and 22% at 3, 6 and 12 months, respectively. In malnourished patients according to MNA-SF, mortality was 5.7 times greater [95%CI 1.3–25.4; p = 0.022] at 6 months and 3.8 times greater [95%CI 1.3–11.6; p = 0.018] at 12 months. In malnourished patients according to SGA, mortality was 3.6 times greater [95%CI 1.02–13.04; p = 0.047] at 3 months, 3.4 times greater [95%CI 1.3–8.6; p = 0.012] at 6 months and 3 times greater [95%CI 1.35–6.7; p = 0.007] at 12 months. Conclusion: The prevalence of malnutrition in patients admitted for fragility hip fracture is high. The SGA and MNA-SF are postulated as adequate tools to diagnose malnutrition in these patients, with predictive value for mortality at three, six, and twelve months.

The aim of our study is to determine if there is an association between phase angle obtained by bioelectrical impedance analysis (BIA) and mortality in older patients with fragility hip fractures. A prospective study of patients over 65 years old and hospitalized with a diagnosis of hip fracture was conducted. BIA was performed 24 to 48 h after surgery. Mortality was recorded, and the optimal phase angle cut-off value for predicting mortality was determined by using receiver operating characteristic (ROC) curves. A total of 262 patients were included. Of the patients studied, 10 (3.8%), 21 (8%), 39 (14.9%) and 53 (20.2%) died at 1, 3, 6 and 12 months after surgery, respectively. The phase angle cut-off for mortality at 12 months was 4.05° in women and 4.65° in men. A total of 94 patients (35.9%) were considered to have a low phase angle. After adjustment for possible confounders, mortality in patients with a low phase angle was 5.1 times higher at 1 month, 3.1 times higher at 3 months, 2.9 times higher at 6 months, and 2.8 times higher at 12 months. Phase angle is associated with prognosis in patients admitted for hip fracture regardless of age and comorbidities and can be positioned as a prognostic tool for mortality at 1, 3, 6 and 12 months.

Purpose: This study evaluates the Social Return on Investment (SROI) of implementing measures to prevent fragility fractures in postmenopausal women with osteoporosis (OP) in Spain. Methods: A group of 13 stakeholders identified necessary actions for improving refracture prevention and assessed the investment required from the Spanish National Health System (SNHS), considering direct, indirect, and intangible costs over a one-year period. Unitary costs were sourced from scientific literature and official data, and intangible costs were estimated through surveys on women’s willingness to pay for better health-related quality of life. The SROI ratio was calculated from both a social perspective (including all returns) and the SNHS perspective (including only direct and intangible costs). A sensitivity analysis evaluated the returns in worst- and best-case scenarios over three years. Results: Stakeholders agreed on four main actions: 1) establishing fracture liaison services; 2) harmonizing clinical practice guidelines and provide training for healthcare professionals (HCPs); 3) promoting HCPs’ adherence to fracture registries and 4) raising awareness of OP and fragility fractures. From the social perspective, implementing these actions would cost the SNHS € 4,375,663 but yield a social return of € 96,939,931 in the first year, resulting in a SROI ratio of € 22.15 per euro invested (€ 28.69, 23.14, 24.29, and 10.70 for the four actions, respectively). From the SNHS perspective, the return would be € 36,453,509 (€ 21,523,444 tangible), with a SROI of € 8.33 (€ 4.92 tangible) and for the four actions: € 9.99, 9.39, 8.45, and 3.79, respectively (€ 5.89, 5.54, 4.96 and 2.27 tangible). The investment would be lower than the return for all actions (3.49%, 4.32%, 4.12% and 9.34% of social perspective return, respectively) and scenarios. Conclusion: According to our SROI method, implementing different actions to improve secondary fracture prevention would achieve a considerable social benefit, which, in terms of direct, indirect, and intangible costs, would far outweigh the investment.

Background: Oral nutritional supplementation (ONS) is commonly prescribed in malnourished older adults after hip fracture, but formulations are heterogeneous, and their comparative association with mortality remains unclear. We aimed to evaluate whether HMB-containing ONS was associated with lower mortality than non-HMB ONS and to explore whether supplement formulation combined with treatment persistence was associated with differential mortality patterns. Methods: This was a formulation-specific subanalysis of a previously described prospective cohort of older adults with hip fracture and malnutrition or significant nutritional risk. Only patients with known ONS formulation were included (n = 107): 59 received HMB-containing ONS, and 48 received non-HMB ONS, including standard, diabetes-specific, and renal-oriented formulations. Mortality at 3, 6, and 12 months was analyzed using crude comparisons and multivariable logistic regression adjusted for sex, age, and Charlson comorbidity index. A 6-month adjusted Cox model was used as the main time-to-event analysis. Exploratory analyses assessed mortality according to supplement formulation and treatment persistence. Results: Overall mortality was 14.0% at 3 months, 23.4% at 6 months, and 29.9% at 12 months. At 6 months, mortality was lower among patients receiving HMB-containing ONS than among those receiving non-HMB ONS (13.6% vs. 35.4%; p = 0.011), and the association remained significant after adjustment (OR 0.267; 95% CI 0.091–0.784; p = 0.016). Associations at 3 and 12 months were directionally consistent but not statistically significant. In the adjusted Cox model, prescription of HMB-containing ONS was associated with a lower hazard of death within 6 months (HR 0.358; 95% CI 0.145–0.885; p = 0.026). Exploratory analyses showed a 6-month mortality gradient according to formulation and persistence, ranging from 0.0% in patients receiving HMB-ONS for ≥3 months to 41.2% in those receiving non-HMB ONS for <3 months. Conclusions: In this formulation-specific subanalysis of malnourished older adults with hip fracture, an association between HMB-containing ONS and lower 6-month mortality was observed compared with non-HMB ONS. Exploratory findings suggested a clinically relevant mortality gradient according to both supplement formulation and treatment persistence, although these results should be interpreted cautiously. Larger prospective studies are warranted to confirm these findings.