Fragility Femoral and Hip Fractures in Saudi Arabia: A Systematic Review of Epidemiology, Risk Factors, Clinical Outcomes, and Health-System Gaps

Fragility hip and femoral fractures are a major cause of morbidity, mortality, and healthcare utilization, yet evidence from Saudi Arabia remains fragmented. This systematic review with narrative synthesis evaluated studies conducted in Saudi Arabia that examined the incidence, risk factors, clinical outcomes, and health-system gaps associated with fragility hip and femoral fractures among adults aged 50 years and older. Searches of PubMed, Scopus, Web of Science, and Google Scholar identified 13 eligible studies published between 2015 and 2025. Across predominantly hospital-based cohorts, hip and femoral fractures accounted for a substantial proportion of orthopedic admissions. Estimates of national fracture burden were derived from individual modeling studies and suggest more than 7,000 femoral fractures annually. Reported one-year mortality varied widely across studies, ranging from approximately 11% to nearly 48%, with higher mortality consistently observed among patients with delayed surgery or higher ASA classification. Functional recovery was frequently limited, and postoperative complications were common. Despite a high prevalence of osteoporosis or osteopenia among fracture patients, osteoporosis diagnosis and secondary prevention were consistently underutilized. Dual-energy X-ray absorptiometry (DEXA) scanning was reported in fewer than 20% of patients, and most individuals received no post-fracture osteoporosis therapy. Studies also highlighted variability in clinical practice, low public awareness, and gaps in postoperative mobilization and follow-up care. Although the evidence base is limited and heterogeneous, the included studies consistently identify delayed surgical care, underdiagnosis and undertreatment of osteoporosis, and system-level practice variability as key challenges in the Saudi context. These findings support the need for locally adapted strategies that prioritize timely surgery, standardized care pathways, and improved secondary fracture prevention.