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.

Introduction: Several factors influence mortality and survival after hip fracture, including nutritional status, which is associated with both incidence and prognosis. However, there is little evidence on the impact of oral nutritional supplements (ONS) on the survival of these patients, and the available results are mixed. Our aim was to analyze the effect of adherence to ONS treatment on post-hospital mortality, with the hypothesis that this would be lower in an adherent group. Methods: Prospective study of patients aged 65 years or older, admitted for fragility hip fracture. Follow-up was carried out at 3, 6 and 12 months to evaluate retrieval of ONS in pharmacies and survival. Adherence was considered if ONS were withdrawn for 3 months or longer. The sample was divided into four groups: (1) well-nourished patients without prescription of ONS, (2) moderately malnourished patients without prescription of ONS, (3) moderate or severely malnourished patients with prescription of ONS but without adherence, and (4) moderately or severely malnourished patients with prescription of ONS and adherence. Mortality between groups was compared by means of a Cox regression, adjusted for confounding variables. Results: 300 patients were included (mean age 82.9 years; 79.3% female), with severe malnutrition in 19.7%. Non-adherent malnourished patients showed a significantly higher risk of death than adherent malnourished patients (HR = 3.67; 95% CI: 1.41–9.57; p = 0.008). Non-adherent malnourished patients had a significantly higher risk of death compared to well-nourished patients (HR = 2.95; 95% CI: 1.31–6.65; p = 0.009). Malnourished patients without ONS had a non-significant higher mortality risk than well-nourished patients (HR = 1.66; 95% CI: 0.72–3.84, p = 0.236). Adherent malnourished patients showed a non-significant trend toward lower mortality than well-nourished patients (HR = 0.80; 95% CI: 0.25–2.56; p = 0.712). Conclusion: In our study, 3-month adherence to ONS is associated with a reduction in 3, 6 and 12-month mortality in older patients with a hip fracture when compared to non-adherent patients and shows a trend toward an improved survival rate than that of well-nourished patients.

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.