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Therapeutic efficacy of zoledronic acid combined with calcitriol in elderly patients receiving total hip arthroplasty or hemiarthroplasty for osteoporotic femoral neck fracture

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Abstract

Summary

Zoledronic acid could improve the clinical outcome in elderly patients receiving total hip arthroplasty or hemiarthroplasty for osteoporotic femoral neck fracture in the 1-year prospective study.

Introduction

To validate the therapeutic efficacy of zoledronic acid (ZOL) in elderly patients with femoral neck fracture who received total hip arthroplasty (THA) or hemiarthroplasty (HA).

Methods

Included in this study were 95 elderly patients with femoral neck fractures who received THA/HA between August 2015 and June 2018. They were randomized into a ZOL group and a control group. Patients in ZOL group received a yearly single dose of 5 mg ZOL intravenous injection plus 0.5 μg/day calcitriol and 1000 mg/day calcium carbonate 2 days before THA or HA. Patients in the control group were treated with the same dose of calcitriol and calcium carbonate only without ZOL. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Bone metabolism markers including the total extension of the peptide type I collagen amino end (P1NP) and beta collagen degradation product (β-CTX) were obtained by serum examination. The postoperative functional outcome was assessed using Harris Hip Score (HHS).

Results

During the follow-up period, BMD in the ZOL group was improved and significantly higher than that in the control group at 6 and 12 months post-operation. Bone metabolism markers P1NP and β-CTX in ZOL group remained at a relatively low level as compared with that in the control group at 6 months after treatment. No significant difference in the mean HHS and the excellent/good rate of joint function was observed during the follow-up period between the two groups. The occurrence of adverse events in the ZOL group was significantly higher than that in the control group.

Conclusions

A single infusion of ZOL shows promise in improving BMD of the healthy side of the femoral neck, lumbar spine, and total hip and decreasing the level of bone markers, which may improve the clinical outcome of patients with osteoporotic femoral neck fractures receiving THA/HA.

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Funding

This work was supported by the “Shanghai Pujiang Young Rheumatologists Training Program (SPROG)”, in the paper.

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Author notes

  1. K. Zhu and J. Zhang contributed equally to this work.

Authors and Affiliations

  1. Jinan University, Guangzhou, China

    K. Zhu

  2. Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China

    K. Zhu, C. Zhang, Z. Zhao & J. Guan

  3. Department of Rheumatology, Changhai Hospital, Shanghai, China

    J. Zhang, J. Gao, X. Li, X. Xia & X. Xu

  4. National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China

    T. Zhang

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  1. K. Zhu
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Corresponding authors

Correspondence to X. Xu, T. Zhang or J. Guan.

Ethics declarations

All patients provided informed consent about reviewing their medical records and the purpose of the study. The protocol of this prospective single-center study was approved by the institutional review board of The First Affiliated Hospital of Bengbu Medical College in accordance with the principles of the Declaration of Helsinki.

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Zhu, K., Zhang, J., Zhang, C. et al. Therapeutic efficacy of zoledronic acid combined with calcitriol in elderly patients receiving total hip arthroplasty or hemiarthroplasty for osteoporotic femoral neck fracture. Osteoporos Int 32, 559–564 (2021). https://doi.org/10.1007/s00198-020-05637-0

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  • DOI: https://doi.org/10.1007/s00198-020-05637-0

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