Modelling the resource implications of starting IV Zoledronate after a femoral fracture.

Introduction

In 2023 the ‘Call to action’ paper recommended giving a first dose of intravenous zoledronate (IV Zol) during hip fracture patients' inpatient stay. However the HORIZON study demonstrated the benefit of annual infusions. To help plan service provision we set out to define the constraints on patients reattending for repeated outpatient IV Zol.

Method

We reviewed local National Hip Fracture Database (NHFD) data for all patients presenting with a femur fracture in 2024. At 120-days a follow-up questionnaire is sent to all patients and we used this to identify those most physically and mentally suitable to return for annual outpatient IV Zol infusions.

Results

A total of 641 patients presented with a femur fracture in 2024, and 392 (61%) received IV Zol as an inpatient. Of these, 33 (8.4%) died before 120-days, but 231 survivors (64%) responded to the 120-day postal survey.

Just 44 (11.2%) of all those who had received IV Zol reported themselves as living in their own home and being mobile using no more than a stick.

At 12 months we performed a focussed review of these 44 patients' electronic medical record. One patient was recorded as having moderate dementia. Seven had been identified for denosumab or anabolic therapy and were under bone clinic or oncology follow up. Seven patients were not osteoporotic on DXA or were still awaiting a DXA scan. Of the respondents, just 29 (7.4%) of those who had received IV Zol as an inpatient appeared mobile and medically appropriate to attend for a repeat infusion.

Conclusion

These results demonstrate that the vast majority of people will only receive a single dose of IV Zol and provide a sense of scale for those considering the outpatient burden that will result from the use of IV Zol as a first line approach to secondary prevention of hip fracture.