In-hospital clinical and pharmacological determinants of 120-day mortality and institutionalization after hip fracture: functional and pharmacological implications in Primary Care

11/09/2026

AI Summary

In-hospital complications, especially delirium and moderate/severe malnutrition, strongly predict 120-day mortality among older hip fracture patients.
Baseline vitamin D supplementation linked to lower mortality in bivariate analysis, but lost independent significance versus comorbidities in multivariate models.
41.5% of previously autonomous survivors required de novo institutionalisation, emphasising coordinated primary care follow up and individualised osteoprotective review.

AI Summary

OBJECTIVE: To evaluate the in-hospital clinical and pharmacological factors predicting mortality and functional outcome at 120 days in an expanded cohort of older adults with hip fracture, analyzing the impact of de novo institutionalization and the role of longitudinal follow-up from Primary Care (PC).

Clinical (established delirium, GLIM malnutrition), pharmacological (vitamin D supplementation, antiresorptive treatment), functional, and social variables were evaluated.

In post-discharge therapeutic adequacy, the analysis of osteoprotective therapy underscores the need for an individualized and coordinated clinical review, assuming that controlling frailty factors is a priority to prevent clinical failure and definitive institutionalization of older adults.

Basic summary

Semergen. 2026 Sep 10;52(7):102842. doi: 10.1016/j.semerg.2026.102842. Online ahead of print.

ABSTRACT

MATERIAL AND METHODS: A prospective, longitudinal, observational study was conducted on a cohort of 340 patients aged ≥ 75 years admitted for a hip fracture. Clinical (established delirium, GLIM malnutrition), pharmacological (vitamin D supplementation, antiresorptive treatment), functional, and social variables were evaluated. Follow-up at 30 and 120 days was conducted from Primary Care. Bivariate analysis and multivariate logistic regression were performed.

RESULTS: The mean age was 88.3 years (73.8% women; n=251). The incidence of established delirium was 2.6% (n=9), and 52.9% (n=180) presented moderate/severe malnutrition. Pharmacologically, 2.6% (n=9) of patients were receiving prior antiresorptive treatment, compared to 31.8% (n=108) supplemented with vitamin D. Overall mortality at 120 days was 17.0% (n=55). Lethality was significantly higher in patients with delirium (66.7% vs. 15.6%; p<0.001) and malnutrition (26.1% vs. 6.2%; p<0.001). In bivariate analysis, baseline vitamin D supplementation was associated with lower medium-term mortality (9.5% vs. 20.5%; p=0.021); however, in the multivariate model, this effect lost independent significance (OR 0.51; 95% CI 0.24-1.10; p=0.085) compared to the weight of clinical comorbidities. A total of 41.5% (n=49) of previously autonomous community-dwelling survivors required de novo institutionalization.

CONCLUSIONS: In-hospital clinical complications determine medium-term vital decline. In post-discharge therapeutic adequacy, the analysis of osteoprotective therapy underscores the need for an individualized and coordinated clinical review, assuming that controlling frailty factors is a priority to prevent clinical failure and definitive institutionalization of older adults.

PMID:42721923 | DOI:10.1016/j.semerg.2026.102842

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