Presentation Details
| Bridging the Gap: Standardizing Osteoporosis Management with Zoledronic Acid in Hip Fracture Patients Jordana Serero1, Teresa Cafaro2, 3. 1McGill University, Montreal, QC, Canada.2Division of General Internal Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada.3Center for Clinical Epidemiology and Community Studies, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada |
Abstract
BACKGROUND: Post–hip fracture osteoporosis pharmacotherapy reduces mortality and refracture risk, yet real-world treatment rates remain low. At our center, a clinical audit of 348 surgically managed hip fractures from 2019–2020 demonstrated that only one patient was discharged on osteoporosis treatment. To address this gap, we implemented a standardized patient order set (POS) for intravenous Zoledronic Acid (ZA). This study evaluates early uptake and adherence following POS introduction.
METHODS: We are conducting a retrospective chart review for patients admitted with operatively managed hip fractures from February 2025 to February 2026, beginning three months after POS implementation. Eligible patients are those presenting to hospital with hip fractures requiring surgical repair. Exclusion criteria include non-operative management and in-hospital fractures.
RESULTS: In the first three months, 41 patients met inclusion criteria. The median age was 84.9 years (SD ±14.7), and 21.9% were male. Prior to admission, 24.4% of patients were on bisphosphonates; 43.9% and 65.9% were receiving calcium and vitamin D, respectively. Post-operatively, ZA was administered to 3 patients (7.3%). Reasons for non-administration included refusal (n=4), vitamin D deficiency (n=3), eGFR <35 mL/min (n=4), hypocalcemia (n=1), and pre-fracture use of other osteoporosis therapy (n=10). Among those not receiving ZA, oral bisphosphonates and denosumab were initiated in 7 (17.1%) and 1 (2.4%) patients, respectively. Overall, 26.8% of patients received guideline-directed pharmacotherapy.
CONCLUSIONS: Although early uptake of ZA remains below 10%, implementation of a structured protocol has produced measurable improvements in secondary fracture prevention. Patients are routinely assessed for treatment candidacy and reversible contraindications, like vitamin D deficiency and hypocalcemia, are corrected earlier. Clinicians are also increasing use of alternative agents when ZA is unsuitable, ensuring opportunities for fracture prevention are not lost. Compared with the pre-protocol cohort, treatment rates have improved, demonstrating the impact of standardized processes on closing care gaps and strengthening osteoporosis management.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: We are conducting a retrospective chart review for patients admitted with operatively managed hip fractures from February 2025 to February 2026, beginning three months after POS implementation. Eligible patients are those presenting to hospital with hip fractures requiring surgical repair. Exclusion criteria include non-operative management and in-hospital fractures.
RESULTS: In the first three months, 41 patients met inclusion criteria. The median age was 84.9 years (SD ±14.7), and 21.9% were male. Prior to admission, 24.4% of patients were on bisphosphonates; 43.9% and 65.9% were receiving calcium and vitamin D, respectively. Post-operatively, ZA was administered to 3 patients (7.3%). Reasons for non-administration included refusal (n=4), vitamin D deficiency (n=3), eGFR <35 mL/min (n=4), hypocalcemia (n=1), and pre-fracture use of other osteoporosis therapy (n=10). Among those not receiving ZA, oral bisphosphonates and denosumab were initiated in 7 (17.1%) and 1 (2.4%) patients, respectively. Overall, 26.8% of patients received guideline-directed pharmacotherapy.
CONCLUSIONS: Although early uptake of ZA remains below 10%, implementation of a structured protocol has produced measurable improvements in secondary fracture prevention. Patients are routinely assessed for treatment candidacy and reversible contraindications, like vitamin D deficiency and hypocalcemia, are corrected earlier. Clinicians are also increasing use of alternative agents when ZA is unsuitable, ensuring opportunities for fracture prevention are not lost. Compared with the pre-protocol cohort, treatment rates have improved, demonstrating the impact of standardized processes on closing care gaps and strengthening osteoporosis management.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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