The HORIZON Recurrent Fracture Trial tested whether once-yearly IV zoledronic acid prevents new fractures in patients who recently had surgical repair of a low-trauma hip fracture. It enrolled 2,127 patients who could not or would not take oral bisphosphonates. The primary endpoint was a new clinical fracture over a median 1.9 years of follow-up.
When a patient comes off the table after hip fracture fixation, the job is not done. This trial shows that starting annual IV zoledronic acid within 90 days reduces the next clinical fracture by 35% and all-cause death by 28%.
The mortality signal is the part to remember. A bisphosphonate improving survival is biologically surprising, and the authors are honest that the mechanism is probably multifactorial and not explained by fracture prevention alone.
The trial also dismantles two common objections. Bisphosphonates did not impair healing of the index fracture, and atrial fibrillation was not increased despite a prior safety concern.
Practically, replete vitamin D before dosing to avoid hypocalcemia, and avoid the drug if creatinine clearance is below 30 mL/min. The once-yearly IV route was chosen precisely because frail elderly patients have poor oral bisphosphonate adherence.
The HORIZON Recurrent Fracture Trial tested whether once-yearly IV zoledronic acid prevents new fractures in patients who recently had surgical repair of a low-trauma hip fracture. It enrolled 2,127 patients who could not or would not take oral bisphosphonates. The primary endpoint was a new clinical fracture over a median 1.9 years of follow-up.
When a patient comes off the table after hip fracture fixation, the job is not done. This trial shows that starting annual IV zoledronic acid within 90 days reduces the next clinical fracture by 35% and all-cause death by 28%.
The mortality signal is the part to remember. A bisphosphonate improving survival is biologically surprising, and the authors are honest that the mechanism is probably multifactorial and not explained by fracture prevention alone.
The trial also dismantles two common objections. Bisphosphonates did not impair healing of the index fracture, and atrial fibrillation was not increased despite a prior safety concern.
Practically, replete vitamin D before dosing to avoid hypocalcemia, and avoid the drug if creatinine clearance is below 30 mL/min. The once-yearly IV route was chosen precisely because frail elderly patients have poor oral bisphosphonate adherence.