Lyles and colleagues tested whether a yearly zoledronic acid infusion, first given within 90 days of hip fracture repair, reduces new clinical fractures and death.
Double‑blind, placebo‑controlled RCT of 2127 patients (mean age 74.5) after hip fracture repair, median follow‑up 1.9 years.
Methods
Design
Double‑blind placebo‑controlled RCT
Patients
2127 randomized
Mean age 74.5
Surgically repaired hip fracture
Groups
Yearly IV zoledronic acid 5 mg (1065)
Yearly IV placebo (1062)
First infusion within 90 days of repair
All received calcium and vitamin D
Follow-up
Median 1.9 years
Primary outcome
New clinical fracture
Outcomes
New clinical vertebral fracture
New nonvertebral fracture
New hip fracture
All‑cause mortality
Bone mineral density
Adverse events
Key Findings
New clinical fractures occurred in 8.6% of the zoledronic acid group vs 13.9% of the placebo group, a 35% relative and 5.3% absolute reduction (p = 0.001).
In the safety population, 9.6% (101 of 1054) of zoledronic acid patients died vs 13.3% (141 of 1057) on placebo (HR 0.72, 95% CI 0.56 to 0.93, p = 0.01).
The 30% relative reduction in new hip fractures was not significant (3.5% in the placebo group).
Delayed union of the index hip fracture was similar (3.2% vs 2.7%, p = 0.61), and no case of jaw osteonecrosis was reported or confirmed, although no specific case‑finding effort was made.
Total hip bone density rose 5.5% by 36 months with zoledronic acid, while it fell 0.9% with placebo.
Pyrexia (8.7% vs 3.1%) and myalgia (4.9% vs 2.7%) were more frequent with zoledronic acid, while atrial fibrillation was similar (1.1% vs 1.3%).
Board pearl
In HORIZON, yearly 5 mg IV zoledronic acid started within 90 days of hip fracture surgery was associated with fewer new clinical fractures and better survival.
Authors' conclusion
An annual infusion of zoledronic acid within 90 days after repair of a low-trauma hip fracture was associated with a reduction in the rate of new clinical fractures and with improved survival.
Lyles and colleagues tested whether a yearly zoledronic acid infusion, first given within 90 days of hip fracture repair, reduces new clinical fractures and death.
Double‑blind, placebo‑controlled RCT of 2127 patients (mean age 74.5) after hip fracture repair, median follow‑up 1.9 years.
Methods
Design
Double‑blind placebo‑controlled RCT
Patients
2127 randomized
Mean age 74.5
Surgically repaired hip fracture
Groups
Yearly IV zoledronic acid 5 mg (1065)
Yearly IV placebo (1062)
First infusion within 90 days of repair
All received calcium and vitamin D
Follow-up
Median 1.9 years
Primary outcome
New clinical fracture
Outcomes
New clinical vertebral fracture
New nonvertebral fracture
New hip fracture
All‑cause mortality
Bone mineral density
Adverse events
Key Findings
New clinical fractures occurred in 8.6% of the zoledronic acid group vs 13.9% of the placebo group, a 35% relative and 5.3% absolute reduction (p = 0.001).
In the safety population, 9.6% (101 of 1054) of zoledronic acid patients died vs 13.3% (141 of 1057) on placebo (HR 0.72, 95% CI 0.56 to 0.93, p = 0.01).
The 30% relative reduction in new hip fractures was not significant (3.5% in the placebo group).
Delayed union of the index hip fracture was similar (3.2% vs 2.7%, p = 0.61), and no case of jaw osteonecrosis was reported or confirmed, although no specific case‑finding effort was made.
Total hip bone density rose 5.5% by 36 months with zoledronic acid, while it fell 0.9% with placebo.
Pyrexia (8.7% vs 3.1%) and myalgia (4.9% vs 2.7%) were more frequent with zoledronic acid, while atrial fibrillation was similar (1.1% vs 1.3%).
Board pearl
In HORIZON, yearly 5 mg IV zoledronic acid started within 90 days of hip fracture surgery was associated with fewer new clinical fractures and better survival.
Authors' conclusion
An annual infusion of zoledronic acid within 90 days after repair of a low-trauma hip fracture was associated with a reduction in the rate of new clinical fractures and with improved survival.