Association between timing of zoledronic acid infusion and hip fracture healing.


Journal Article

Patients in the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly (HORIZON) Recurrent Fracture Trial were assessed for evidence of delayed hip fracture healing. No association was observed between zoledronic acid (ZOL) and delayed healing. We conclude that ZOL has no clinically evident effect on fracture healing, even when the drug is infused in the immediate postoperative period.Intravenous zoledronic acid 5 mg (ZOL) given after a hip fracture reduces secondary fracture rates and mortality. It has been postulated that bisphosphonates may affect healing if given soon after a fracture. We sought to determine whether the timing of ZOL infusion affected the risk of delayed hip fracture healing.In the HORIZON Recurrent Fracture Trial, patients were randomized within 90 days of a low-trauma hip fracture to receive either once-yearly ZOL (n = 1,065) or placebo (n = 1,062). Clinical symptoms of delayed hip fracture healing were sought at randomization, 6 months and 12 months after fracture; if present, a central adjudication committee blinded to treatment assignment reviewed radiographs and clinical records. Median follow-up was 1.9 years.The overall incidence of delayed healing was 3.2% (ZOL) and 2.7% (placebo; odds ratio [OR], 1.17; 95% confidence interval [CI], 0.72-1.90; p = 0.61). Logistic regression models revealed no association between ZOL and delayed healing even after adjusting for other risk factors (OR, 1.21; 95% CI, 0.74-1.99; p = 0.44). There was no interaction by timing of infusion, and nonunion rates were similar even when ZOL was given within 2 weeks of hip fracture repair. NSAID use was significantly associated with delayed fracture healing (OR, 2.55; 95% CI, 1.49-4.39; p < 0.001).ZOL has no clinically evident effect on fracture healing, even when the drug is infused in the immediate postoperative period.

Full Text

Duke Authors

Cited Authors

  • Colón-Emeric, C; Nordsletten, L; Olson, S; Major, N; Boonen, S; Haentjens, P; Mesenbrink, P; Magaziner, J; Adachi, J; Lyles, KW; Hyldstrup, L; Bucci-Rechtweg, C; Recknor, C; HORIZON Recurrent Fracture Trial,

Published Date

  • August 2011

Published In

Volume / Issue

  • 22 / 8

Start / End Page

  • 2329 - 2336

PubMed ID

  • 21153021

Pubmed Central ID

  • 21153021

Electronic International Standard Serial Number (EISSN)

  • 1433-2965

International Standard Serial Number (ISSN)

  • 0937-941X

Digital Object Identifier (DOI)

  • 10.1007/s00198-010-1473-1


  • eng