RESULTS Nine studies were eligible for inclusion. They were further categorised into six cohort groups. All studies had denosumab with oral bisphosphonates as the active comparator. Four out of six cohort studies showed significant improvements in bone strength (p < 0.001) at the distal radius, tibia, total hip, femoral neck, lumbar spine and trochanter at 12 months for patients on denosumab compared to the bisphosphonate group. Serum C-telopeptide of cross-linked collagen, a bone turnover marker, was consistently lower in the denosumab group in all studies. There were no significant differences in hypocalcaemia, atypical fractures, fragility fractures, osteonecrosis of the jaw, all infections (including fever or influenza-like symptoms), gastrointestinal side effects or dermatological conditions in all studies, except for one that did not document side effects. CONCLUSION Denosumab can be used both as a first-line agent and an alternative to bisphosphonate in the treatment of postmenopausal osteoporosis. There is currently insufficient data to show that denosumab is not inferior to bisphosphonates in fracture prevention.

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Introduction Fear of Falling (FoF) is common after hip fracture and associated with adverse outcomes including impaired functional recovery and recurrent falls. The objective of this study was to measure self-efficacy related to falls and its association with functional outcomes after hip fracture surgery. Methods A prospective cohort study was performed on 106 community-dwelling elderly aged ≥65 years without dementia, admitted to a community hospital for rehabilitation after surgery for fragility hip fracture in Singapore. They were managed in an integrated multidisciplinary orthogeriatric programme, transitioning from acute orthopaedic unit to the affiliated community hospital. Falls Efficacy Scale (FES; range 10-100) was assessed on discharge. Main outcomes measured included Parker Mobility Score (PMS) and Modified Barthel Index (MBI) at 3 months. Results Key characteristics of the cohort were: mean age 79.4(SD 6.38); female 74%, Chinese 83%, pre-fracture PMS 6.7(SD 2.7); pre-fracture MBI 81.1(SD 20.9); mean FES score 32.0(SD 23.7). At 3 months, mean PMS was 3.97(SD 2.51); mean MBI was 73(SD 20.1), demonstrating that the cohort overall did not regain their pre-morbid functional levels. FES was negatively correlated with both 3-month MBI and PMS with coefficients -0.592 and -0.523 respectively (p&lt;0.001). FES was negatively associated with 3-month MBI and PMS in the multiple linear regression model, having adjusted for demographics, comorbidities, pre-fracture MBI and PMS, MMSE, geriatric depression scale, and post-operative weight-bearing status, with corresponding βs -0.26(95%CI -0.49 to -0.02;p=0.032) and -0.03(95%CI -0.06 to -0.00;p=0.044). Conclusion FoF is a potentially modifiable factor linked to adverse functional outcomes in hip fracture rehabilitation, indicating the necessity to address falls self-efficacy as a major component of assessment and intervention, whilst further exploring the local validity and applicability of various instruments measuring FoF. Further studies need to be conducted on the evolving patterns of FoF over time and its impact on longer-term functional and psychosocial outcomes.

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Background. Unplanned readmission to hospital is common among older adults and contributes to considerable healthcare costs and hospital-associated complications. We aimed to identify predictors of 30-day post-discharge unplanned readmission among older adults in our subacute geriatric ward, and to determine the prevalence of geriatric syndromes and develop a new predictive model for readmission of subacute geriatric patients.Methods: Consecutive patients admitted to our subacute geriatric ward between June 2018 and June 2019 were invited to participate. Data collected included patient age, sex, weight, height, race, type of housing, destination upon discharge, functional and frailty status, presence of conduits (urinary catheters and nasogastric tubes), polypharmacy, high-risk medications, healthcare utilisation 6 months prior, laboratory test results, length of hospital stay, Charlson Comorbidity Index, and LACE index. Patients were assessed using the Mini Nutritional Assessment -Short Form, Geriatric Depression Scale, Mini-Mental State Examination, Clinical Frailty Scale, FRAIL scale, modified Barthel Index, hand grip strength, and gait speed. Patients with or without 30-day post-discharge unplanned readmission were compared. Multivariate logistic regression was used to identify independent predictors. Results: Of 284 patients followed up at 30 days post-discharge, 63 (22.2%) had unplanned hospital readmission within 30 days of discharge, with associated factors being history of myocardial infarction, moderate or severe liver or renal disease, low albumin level, history of emergency department visits, hospitalisation in the preceding 6 months, and discharge to a destination other than home. The prevalence of geriatric syndromes of falls, frailty, and immobility was 62.3%, 64.7%, and 86.6%, respectively. Independent predictors of 30-day post-discharge unplanned readmission were history of hospitalisation in the preceding 6 months (odds ratio=2.62, p=0.045) and discharge destination other than home (odds ratio=3.10, p=0.006). The area under the receiver operating characteristics curve for the predictive models was between 0.6 and 0.7, and Brier score was around 0.16. The discrimination ability of the models was weak. Conclusion:History of hospitalisation in the preceding 6 months and not being discharged to home were independent predictors for 30-day post-discharge unplanned readmission.