Effect of denosumab combination with proximal femoral nail antirotation surgery in elderly patients with intertrochanteric femoral fractures: A comparative study.

Abstract

To evaluate the effect of denosumab combined with proximal femoral nail antirotation (PFNA) surgery in elderly patients with osteoporotic intertrochanteric femoral fractures (ITF Fx). This retrospective, comparative study included patients aged ≥65 years with osteoporotic ITF Fx who underwent PFNA fixation at Huai'an Second People's Hospital between July 2021 and July 2023. Pain relief (visual analogue scale, VAS), hip function, bone mineral density (BMD), time to fracture healing, refracture rate, and adverse events were compared. This is a retrospective study, without the addition of any intervention measures. A total of 76 patients were included, with 38 patients in the denosumab + PFNA group and 38 in the PFNA group. The denosumab + PFNA group showed significantly greater improvements in pain relief (1.68 ± 0.93 vs 2.29 ± 0.97, <i>p</i> = 0.014) and BMD T-score (-1.49 ± 0.61 vs -1.98 ± 0.52, <i>p</i> = 0.006) at 12 months compared to the PFNA group. Fracture healing time was significantly shorter in the denosumab + PFNA group (12.37 ± 1.38 vs 13.63 ± 1.34 weeks, <i>p</i> < 0.001), and the refracture rate was significantly lower (2.63 % vs 21.05 %, <i>p</i> < 0.05) than that in the PFNA group. The post-treatment hip function was comparable between the denosumab + PFNA and PFNA groups. Only one case of hypocalcemia was reported in the denosumab + PFNA group (2.63 %). Denosumab combined with PFNA surgery might have an advantage in pain relief, BMD T-score, and fracture healing, while reducing refracture risk in elderly patients with osteoporotic ITF Fx compared with PFNA surgery alone.