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Altered martial indices before orthopedic surgery are associated with higher rates of complications and greatly affect the patient&#8217;s functional ability. Oral supplements can optimize the preoperative martial status, with clinical efficacy and the patient&#8217;s tolerability being highly dependent on the pharmaceutical formula. Patients undergoing elective hip/knee arthroplasty were randomized to be supplemented with a 30-day oral therapy of sucrosomial ferric pyrophosphate plus L-ascorbic acid. The tolerability was 2.7% among treated patients. Adjustments for confounding factors, such as iron absorption influencers, showed a relevant response limited to older patients (&#8805; 65 years old), whose uncharacterized Hb loss was averted upon treatment with iron formula. Older patients with no support lost &#8722;2.8 &#177; 5.1%, while the intervention group gained +0.7 &#177; 4.6% of circulating hemoglobin from baseline (<i>p</i> = 0.019). Gastrointestinal diseases, medications, and possible dietary factors could affect the efficacy of iron supplements. Future opportunities may consider to couple ferric pyrophosphate with other nutrients, to pay attention in avoiding absorption disruptors, or to implement interventions to obtain an earlier martial status optimization at the population level.