Clinical Practice Assessment Zoledronic Acid （临床实践评估Zoledronic酸）.pdfVIP

Clinical Practice Assessment Zoledronic Acid after a Hip Fracture Clinical Question: Does intravenous bisphosphonate therapy with zoledronic acid administered after osteoporotic hip fractures reduce the frequency of subsequent fractures or mortality? Bottom Line: Once-yearly IV zoledronic acid administered initially within 90 days of an osteoporotic hip fracture resulted in a significant reduction in subsequent fractures (ARR 5.3%; NNT 19) and mortality (ARR 3.7%; NNT 27) over 2 years. Strength of Recommendation- A (SORT). Synopsis: The HORIZON Recurrent Fracture Trial was a manufacturer sponsored multi-center, randomized, double- blind, placebo-controlled study designed to evaluate the efficacy and safety of zoledronic acid in preventing subsequent fractures following the surgical repair of a low-trauma hip fracture. The trial randomized 2127 patients to receive 5 mg zoledronic acid IV once yearly (n=1065) or placebo (n=1062). The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients were followed up for a median of 1.9 years. Patients being treated with oral bisphosphonates or teriparatide were excluded, but other osteoporosis treatments were allowed at the discretion of the investigator. The two groups were well matched with regard to race, age, sex, bone mineral density and T-score but no information was given about co- morbidities such as cardiovascular risk factors. There was a significant reduction in subsequent fractures, and a reduction in mortality (Table 1). An aspect of the study that could affect the generalizability of the findings is that the patients, on average, were slightly younger and healthier than hip fracture patients in the general population. There was also a slight imbalance in the randomization such that slightly more patients in the control group received other adjunctive therap