Nurse-Led Gastrointestinal Tolerability–Adapted Osteoporosis Care After Hip Fracture: 24-Month Implementation Outcomes

Older adults remain at high risk for subsequent fragility fractures after hip fracture; however, post-discharge anti-osteoporosis therapy is frequently delayed, interrupted, or discontinued. This single-center, non-randomized longitudinal implementation study evaluated a nurse-led gastrointestinal (GI) tolerability-adapted osteoporosis care pathway for older adults following surgical treatment of hip fracture. A total of 147 participants were enrolled, including 73 in the nurse-led pathway group and 74 in the usual care group. The intervention incorporated discharge-time GI tolerability risk stratification, safety verification, tolerability-adapted regimen selection, standardized patient education, structured follow-up at 1 week and 1, 3, 6, 12, 18, and 24 months, and predefined criteria for treatment reassessment. Outcomes included implementation fidelity, timely treatment initiation, medication adherence measured by the proportion of days covered (PDC), treatment persistence, changes in bone mineral density (BMD), GI adverse events, and first confirmed subsequent fragility fracture. Compared with usual care, the nurse-led pathway achieved higher rates of GI risk stratification, education checklist completion, safety laboratory review, timely therapy initiation, follow-up completion, and dual-energy X-ray absorptiometry (DXA) assessment. Mean PDC and the proportion of participants achieving a PDC ≥0.80 were consistently higher in the intervention group throughout the 24-month follow-up. Lumbar spine and total hip BMD demonstrated greater improvements in the pathway group, whereas femoral neck BMD changes were smaller. Time-to-event analyses for subsequent fragility fractures favored the intervention group but should be interpreted with caution, given the limited number of events and the non-randomized study design. These findings demonstrate that a nurse-led GI tolerability-adapted osteoporosis care pathway is feasible and may improve treatment continuity following hip fracture. Larger multicenter randomized studies are warranted to confirm its effects on BMD and refracture outcomes.