Zoledronic acid for hip fracture during initial hospitalization

Area of Science:

• Gerontology
• Orthopedics
• Pharmacology

Background:

• Inpatient zoledronic acid (IP-ZA) improves osteoporosis treatment rates post-fracture.
• Clinical outcomes of IP-ZA following hip fracture require further investigation.

Purpose of the Study:

• To evaluate the risk of all-cause mortality and subsequent new fractures in hip fracture patients receiving IP-ZA.
• To compare outcomes between IP-ZA recipients and propensity-matched controls using real-world data.

Main Methods:

• A cohort study emulating a randomized controlled trial using real-world data.
• Inclusion of 654 patients receiving IP-ZA and 6877 controls (indicated for treatment but not receiving IP-ZA).
• Propensity score matching to create a primary cohort of 652 IP-ZA patients and 1926 controls.

Main Results:

• IP-ZA group showed significantly lower 24-month all-cause mortality (12.3% vs 20.7%, HR 0.62, p < .001).
• Rates of radiologically confirmed subsequent new vertebral fractures were lower in the IP-ZA group (2.0% vs 5.4%, HR 0.40, p = .001).
• A single dose of zoledronic acid also demonstrated significant reductions in mortality and new vertebral fractures.

Conclusions:

• IP-ZA administered during initial hip fracture hospitalization is associated with reduced all-cause mortality.
• IP-ZA significantly lowers the risk of subsequent radiologically confirmed vertebral fractures.
• IP-ZA offers a viable strategy to decrease the treatment gap in hip fragility fracture patients.