HORIZON-RFT

Zoledronic acid and clinical fractures and mortality after hip fracture.

Lyles KW, Colón-Emeric CS, Magaziner JS, et al. The New England journal of medicine 2007 · PMID 17878149 · doi:10.1056/nejmoa074941

Question

Does annual zoledronic acid started after surgery for a low-trauma hip fracture reduce subsequent fractures and death?

Design

International multicentre double-blind placebo-controlled RCT.

Patients

Men and women who had undergone surgical repair of a low-trauma hip fracture, with infusion given within 90 days of surgery.

Intervention

Zoledronic acid 5 mg IV yearly (with calcium and vitamin D)

Comparison

Placebo infusion (with calcium and vitamin D)

Primary outcome

New clinical fracture over the follow-up period

Key result

Zoledronic acid significantly reduced new clinical fractures (by about a third) and was associated with a significant reduction in all-cause mortality.

Limitations

Mortality benefit was a secondary outcome and its mechanism is uncertain; a relatively modest proportion of eligible hip fracture patients were enrolled.

Impact on practice

Underpins secondary fracture prevention after hip fracture, including inpatient or early post-discharge zoledronate via orthogeriatric services and Fracture Liaison Services.