title: Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture.
abstract: Annual infusions of zoledronic acid (5 mg) significantly reduced the risk of vertebral, hip, and nonvertebral fractures in a study of postmenopausal women with osteoporosis and significantly reduced clinical fractures and all-cause mortality in another study of women and men who had recently undergone surgical repair of hip fracture. In this analysis, we examined whether timing of the first infusion of zoledronic acid study drug after hip fracture repair influenced the antifracture efficacy and mortality benefit observed in the study. A total of 2127 patients (1065 on active treatment and 1062 on placebo; mean age, 75 yr; 76% women and 24% men) were administered zoledronic acid or placebo within 90 days after surgical repair of an osteoporotic hip fracture and annually thereafter, with a median follow-up time of 1.9 yr. Median time to first dose after the incident hip fracture surgery was approximately 6 wk. Posthoc analyses were performed by dividing the study population into 2-wk intervals (calculated from time of first infusion in relation to surgical repair) to examine effects on BMD, fracture, and mortality. Analysis by 2-wk intervals showed a significant total hip BMD response and a consistent reduction of overall clinical fractures and mortality in patients receiving the first dose 2-wk or later after surgical repair. Clinical fracture subgroups (vertebral, nonvertebral, and hip) were also reduced, albeit with more variation and 95% CIs crossing 1 at most time points. We concluded that administration of zoledronic acid to patients suffering a low-trauma hip fracture 2 wk or later after surgical repair increases hip BMD, induces significant reductions in the risk of subsequent clinical vertebral, nonvertebral, and hip fractures, and reduces mortality.
authors.affiliation: Novartis Pharma, Basel, Switzerland. efinkeriksen@live.com
authors.forename: Erik Fink
authors.initials: EF
authors.lastname: Eriksen
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Lyles
authors.forename: Cathleen S
authors.initials: CS
authors.lastname: Colón-Emeric
authors.forename: Carl F
authors.initials: CF
authors.lastname: Pieper
authors.forename: Jay S
authors.initials: JS
authors.lastname: Magaziner
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.forename: Lars
authors.initials: L
authors.lastname: Hyldstrup
authors.forename: Chris
authors.initials: C
authors.lastname: Recknor
authors.forename: Lars
authors.initials: L
authors.lastname: Nordsletten
authors.forename: Catherine
authors.initials: C
authors.lastname: Lavecchia
authors.forename: Huilin
authors.initials: H
authors.lastname: Hu
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.forename: Peter
authors.initials: P
authors.lastname: Mesenbrink
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D004164:Diphosphonates / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D016103:Spinal Fractures / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid