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Association between timing of zoledronic acid infusion and hip fracture healing.
Osteoporos Int. 2011 Aug; 22(8):2329-36.OI

Abstract

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.

INTRODUCTION

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

ZOL has no clinically evident effect on fracture healing, even when the drug is infused in the immediate postoperative period.

Authors+Show Affiliations

Duke University Medical Center and the Geriatrics Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, NC, USA. colon001@mc.duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21153021

Citation

Colón-Emeric, C, et al. "Association Between Timing of Zoledronic Acid Infusion and Hip Fracture Healing." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 22, no. 8, 2011, pp. 2329-36.
Colón-Emeric C, Nordsletten L, Olson S, et al. Association between timing of zoledronic acid infusion and hip fracture healing. Osteoporos Int. 2011;22(8):2329-36.
Colón-Emeric, C., Nordsletten, L., Olson, S., Major, N., Boonen, S., Haentjens, P., Mesenbrink, P., Magaziner, J., Adachi, J., Lyles, K. W., Hyldstrup, L., Bucci-Rechtweg, C., & Recknor, C. (2011). Association between timing of zoledronic acid infusion and hip fracture healing. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 22(8), 2329-36. https://doi.org/10.1007/s00198-010-1473-1
Colón-Emeric C, et al. Association Between Timing of Zoledronic Acid Infusion and Hip Fracture Healing. Osteoporos Int. 2011;22(8):2329-36. PubMed PMID: 21153021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between timing of zoledronic acid infusion and hip fracture healing. AU - Colón-Emeric,C, AU - Nordsletten,L, AU - Olson,S, AU - Major,N, AU - Boonen,S, AU - Haentjens,P, AU - Mesenbrink,P, AU - Magaziner,J, AU - Adachi,J, AU - Lyles,K W, AU - Hyldstrup,L, AU - Bucci-Rechtweg,C, AU - Recknor,C, AU - ,, Y1 - 2010/12/09/ PY - 2010/07/08/received PY - 2010/10/05/accepted PY - 2010/12/15/entrez PY - 2010/12/15/pubmed PY - 2012/1/11/medline SP - 2329 EP - 36 JF - Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA JO - Osteoporos Int VL - 22 IS - 8 N2 - UNLABELLED: 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. INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: ZOL has no clinically evident effect on fracture healing, even when the drug is infused in the immediate postoperative period. SN - 1433-2965 UR - https://www.unboundmedicine.com/medline/citation/21153021/Association_between_timing_of_zoledronic_acid_infusion_and_hip_fracture_healing_ L2 - https://doi.org/10.1007/s00198-010-1473-1 DB - PRIME DP - Unbound Medicine ER -