Effect of zoledronic acid on functional outcome in cases of pertrochanteric femoral fractures in elderly patients operated with proximal femoral nailing
Keywords:Functional outcome, Harris hip score, Low-energy pertrochanteric fractures, Osteoporosis, Zoledronic acid
Background: Osteoporosis is a very common problem in geriatric population and postmenopausal women. Zoledronic acid injection is a very convenient and effective treatment option available for osteoporosis. Our study aimed to study the effect of zoledronic acid on functional outcome and fracture related complications in elderly patients with low energy pertrochanteric femoral fractures who were operated with proximal femoral nail.
Methods: This was a case control study. Elderly patients who underwent surgery in the form of proximal femoral nailing for low energy pertrochanteric femoral fractures were included. Injection zoledronic acid was given to every alternate patient who underwent surgery. Radiological healing was evaluated at six weekly intervals for six months and then 12 weekly intervals for one year. The Harris hip score was used to measure the functional outcome of the patient.
Results: Effective study population consisted of total 49 patients (25 cases and 24 controls). The mean union time in the cases and the control was 8.76±9.12 weeks and 7.04±1.57 weeks respectively. The mean Harris hip score was 86.742±7.55 in the cases and 84.339±11.20 in the control group. The p value was 0.3815. This study concluded that the two groups had no statistically significant difference between functional outcome and fracture related complications.
Conclusions: Zoledronic acid in patients admitted for surgery with osteoporotic fracture does not improve the functional outcome of the patients. It does not affect the mortality of the patients.
Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D. Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporos Int. 1997;7(4):390-406.
Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017;4(1):46-56.
Office of the Surgeon General (US). Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004.
Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, Melton LJ 3rd. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993;137(9):1001-5.
Kim JH, Park YS, Oh KJ, Choi HS. Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis. Osteoporos Sarcopen. 2017;3(4):164-9.
Pande K, Pande S, Tripathi S, Kanoi R, Thakur A, Patle S. Poor knowledge about osteoporosis in learned Indian women. J Assoc Phys India. 2005;53:433-6.
Malhotra N, Mithal A. Osteoporosis in Indians. Indian J Med Res. 2008;127(3):263-8.
LeBlanc KE, Muncie HL Jr, LeBlanc LL. Hip fracture: diagnosis, treatment, and secondary prevention. Am Fam Phys. 2014;89(12):945-51.
Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. 2008;83(9):1032-45.
Tu KN, Lie JD, Wan CK, Cameron M, Austel AG, Nguyen JK, et al. Osteoporosis: a review of treatment options. Pharm Therap. 2018;43(2):92.
Kates SL, Ackert-Bicknell CL. How do bisphosphonates affect fracture healing? Injury. 2016;47(01):S65-8.
Colón-Emeric C, Nordsletten L, Olson S, Major N, Boonen S, Haentjens P, Mesenbrink P, Magaziner J, Adachi J, Lyles KW, Hyldstrup L. Association between timing of zoledronic acid infusion and hip fracture healing. Osteoporosis international. 2011 Aug;22:2329-36.
Liu Z, Li CW, Mao YF, Liu K, Liang BC, Wu LG, et al. Study on zoledronic acid reducing acute bone loss and fracture rates in elderly postoperative patients with intertrochanteric fractures. Orthopaed Surg. 2019;11(3):380-5.
Lyles KW, Colón-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007;357(18):1799-809.
Gillissen A, Henriquez DD, van den Akker T, Caram-Deelder C, Wind M, Zwart JJ, et al. The effect of tranexamic acid on blood loss and maternal outcome in the treatment of persistent postpartum hemorrhage: a nationwide retrospective cohort study. PloS One. 2017;12(11):e0187555.
Rogers MJ, Crockett JC, Coxon FP, Mönkkönen J. Biochemical and molecular mechanisms of action of bisphosphonates. Bone. 2011;49(1):34-41.
Mollazadeh S, Fazly Bazzaz BS, Kerachian MA. Role of apoptosis in pathogenesis and treatment of bone-related diseases. J Orthop Surg Res. 2015;10:15.
Bergman J, Nordström A, Nordström P. Bisphosphonate use after clinical fracture and risk of new fracture. Osteoporos Int. 2018;29(4):937-45.
Hayer PS, Deane AK, Agrawal A, Maheshwari R, Juyal A. Effect of zoledronic acid on fracture healing in osteoporotic patients with intertrochanteric fractures. Int J Appl Basic Med Res. 2017;7(1):48-52.
Li Y, Zhao WB, Wang DL, He Q, Li Q, Pei FX, et al. Treatment of osteoporotic intertrochanteric fractures by zoledronic acid injection combined with proximal femoral nail anti-rotation. Chinese J Traumatol. 2016;19(05):259-63.
Cengiz Ö, Polat G, Karademir G, Tunç OD, Erdil M, Tuncay İ, et al. Effects of zoledronate on mortality and morbidity after surgical treatment of hip fractures. Adv Orthoped. 2016;2016.
Savaridas T, Wallace RJ, Salter DM, Simpson AH. Do bisphosphonates inhibit direct fracture healing? A laboratory investigation using an animal model. Bone Joint J. 2013;95-B(9):1263-8.
Solomon DH, Hochberg MC, Mogun H, Schneeweiss S. The relation between bisphosphonate use and non-union of fractures of the humerus in older adults. Osteoporos Int. 2009;20(6):895-901.
Lim EJ, Kim JT, Kim CH, Kim JW, Chang JS, Yoon PW. Effect of preoperative bisphosphonate treatment on fracture healing after internal fixation treatment of intertrochanteric femoral fractures. Hip Pelvis. 2019;31(2):75-81.