title: Zoledronic acid and clinical fractures and mortality after hip fracture.
abstract: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed.
  
  
  
  In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients (mean age, 74.5 years) received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture.
  
  
  
  The rates of any new clinical fracture were 8.6% in the zoledronic acid group and 13.9% in the placebo group, a 35% risk reduction with zoledronic acid (P=0.001); the respective rates of a new clinical vertebral fracture were 1.7% and 3.8% (P=0.02), and the respective rates of new nonvertebral fractures were 7.6% and 10.7% (P=0.03). In the safety analysis, 101 of 1054 patients in the zoledronic acid group (9.6%) and 141 of 1057 patients in the placebo group (13.3%) died, a reduction of 28% in deaths from any cause in the zoledronic acid group (P=0.01). The most frequent adverse events in patients receiving zoledronic acid were pyrexia, myalgia, and bone and musculoskeletal pain. No cases of osteonecrosis of the jaw were reported, and no adverse effects on the healing of fractures were noted. The rates of renal and cardiovascular adverse events, including atrial fibrillation and stroke, were similar in the two groups.
  
  
  
  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. (ClinicalTrials.gov number, NCT00046254 [ClinicalTrials.gov].).
authors: Duke University Medical Center, Durham, NC, USA.
authors: Kenneth W
authors: KW
authors: Lyles
authors: Cathleen S
authors: CS
authors: Colón-Emeric
authors: Jay S
authors: JS
authors: Magaziner
authors: Jonathan D
authors: JD
authors: Adachi
authors: Carl F
authors: CF
authors: Pieper
authors: Carlos
authors: C
authors: Mautalen
authors: Lars
authors: L
authors: Hyldstrup
authors: Chris
authors: C
authors: Recknor
authors: Lars
authors: L
authors: Nordsletten
authors: Kathy A
authors: KA
authors: Moore
authors: Catherine
authors: C
authors: Lavecchia
authors: Jie
authors: J
authors: Zhang
authors: Peter
authors: P
authors: Mesenbrink
authors: Patricia K
authors: PK
authors: Hodgson
authors: Ken
authors: K
authors: Abrams
authors: John J
authors: JJ
authors: Orloff
authors: Zebulun
authors: Z
authors: Horowitz
authors: Erik Fink
authors: EF
authors: Eriksen
authors: Steven
authors: S
authors: Boonen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002118:Calcium / Q000627:therapeutic use; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control*; D006620:Hip Fractures / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D014807:Vitamin D / Q000627:therapeutic use; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D014807:Vitamin D; D000077211:Zoledronic Acid; D002118:Calcium