Clinical efficacy of proximal femoral nail antirotation (PFNA) combined with denosumab in the treatment of osteoporotic intertrochanteric fractures

To investigate the clinical impact of PFNA internal fixation combined with denosumab on fracture healing, bone mineral density (BMD), hip joint functional recovery, and refracture incidence in patients with osteoporotic intertrochanteric fractures. A total of 99 elderly patients with osteoporotic intertrochanteric fractures treated with PFNA at the Third Hospital of Hebei Medical University from January 1, 2022, to May 1, 2024, were enrolled. They were divided into two groups based on whether denosumab was administered for anti-osteoporosis therapy: the study group ( n = 49) and the control group ( n = 50). Postoperative X-rays were reviewed to evaluate fracture healing (callus formation) and refracture occurrence. Hip joint function and pain severity were assessed using the Harris Hip Score (HHS) and Visual Analogue Scale (VAS) at postoperative day 1, 1 month, 3 months, 6 months, and 12 months. BMD at the lumbar spine and hip was measured preoperatively and at 6 and 12 months postoperatively. No statistically significant differences were observed between the two groups in baseline characteristics, including gender, age, height, weight, fracture classification, preoperative VAS scores, hip function, or BMD (all P > 0.05). During follow-up, radiographic evaluation revealed significantly better fracture healing in the study group compared to the control group ( P < 0.05), with a lower incidence of refracture in the study group ( P < 0.05). At 6 and 12 months postoperatively, BMD in both groups increased compared to preoperative levels, but the improvement was more pronounced in the study group ( P < 0.05). VAS scores decreased progressively in both groups at 1, 3, 6, and 12 months postoperatively, with greater pain relief in the study group ( P < 0.05). Similarly, HHS scores improved significantly in both groups at 6 and 12 months, but the study group demonstrated superior functional recovery ( P < 0.05). PFNA internal fixation combined with denosumab promotes fracture healing, enhances hip function recovery, improves BMD, and effectively reduces the risk of refracture in patients with osteoporotic intertrochanteric fractures. This combined approach represents a viable clinical treatment strategy. The data collection measures employed in this study utilized mature and validated therapeutic interventions, posing a very low probability of adverse effects on participants.The limitations of this study include its relatively small sample size and the necessity for longer-term follow-up observations.