Osteoporosis International

, Volume 22, Issue 9, pp 2539–2549 | Cite as

Zoledronic acid results in better health-related quality of life following hip fracture: the HORIZON–Recurrent Fracture Trial

  • J. D. Adachi
  • K. W. Lyles
  • C. S. Colón-Emeric
  • S. Boonen
  • C. F. Pieper
  • C. Mautalen
  • L. Hyldstrup
  • C. Recknor
  • L. Nordsletten
  • K. A. Moore
  • C. Bucci-Rechtweg
  • G. Su
  • E. F. Eriksen
  • J. S. Magaziner
Original Article



This study evaluated the benefits of ZOL versus placebo on health-related quality of life (HRQoL) among patients from HORIZON–RFT. At month 24 and end of the study visit, ZOL significantly improved patients’ overall health state compared to placebo as assessed by the EQ-5D VAS.


To evaluate the benefits of zoledronic acid (ZOL) versus placebo on health-related quality of life (HRQoL) among patients from The Health Outcomes and Reduced Incidence With Zoledronic Acid Once Yearly Recurrent Fracture Trial (HORIZON–RFT).


In this randomized, double-blind, placebo-controlled trial, 2,127 patients were randomized to receive annual infusion of ZOL 5 mg (n = 1,065) or placebo (n = 1,062) within 90 days after surgical repair of low-trauma hip fracture. HRQoL was measured using EQ-5D Visual Analogue Scale (VAS) and utility scores (EuroQol instrument) at months 6, 12, 24, 36, and end of the study visit. Analysis of covariance model included baseline EQ-5D value, region, and treatment as explanatory variables.


At baseline, patients (mean age 75 years; 24% men and 76% women) were well matched between treatment groups with mean EQ-5D VAS of 65.82 in ZOL and 65.70 in placebo group. At the end of the study, mean change from baseline in EQ-5D VAS was greater for ZOL vs. placebo in all patients (7.67 ± 0.56 vs. 5.42 ± 0.56), and in subgroups of patients experiencing clinical vertebral fractures (8.86 ± 4.91 vs. −1.69 ± 3.42), non-vertebral fractures (5.03 ± 2.48 vs. −1.07 ± 2.16), and clinical fractures (5.19 ± 2.25 vs. −0.72 ± 1.82) with treatment difference significantly in favor of ZOL. EQ-5D utility scores were comparable for ZOL and placebo groups, but more patients on placebo consistently had extreme difficulty in mobility (1.74% for ZOL vs. 2.13% for placebo; p = 0.6238), self-care (4.92% vs. 6.69%; p = 0.1013), and usual activities (10.28% vs. 12.91%; p = 0.0775).


ZOL significantly improves HRQoL in patients with low-trauma hip fracture.


EQ-5D Health-related QoL Low-trauma hip fracture Zoledronic acid 



The authors thank Dr. Nandita Adhikary (Novartis Healthcare Pvt. Ltd.) for her assistance in writing the manuscript and incorporating authors’ comments into subsequent revisions. Dr. Boonen is a senior clinical investigator of the Fund for Scientific Research, Flanders, Belgium (F.W.O.-Vlaanderen) and holder of the Leuven University Chair in Gerontology and Geriatrics. This research was sponsored by Novartis Pharma AG, Basel, Switzerland.

Conflicts of interest

Dr. Adachi reports receiving consulting fees from Amgen, AstraZeneca, Eli Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer, Procter & Gamble, Roche, Sanofi-Aventis, and Servier and grant support from Amgen, Eli Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer, Procter & Gamble, and Roche.

Dr. Lyles, receiving grant support from Novartis, the Alliance for Better Bone Health (Sanofi-Aventis and Procter & Gamble), and Amgen, consulting fees from Novartis, Procter & Gamble, Merck, Amgen, GTx, GlaxoSmithKline, Eli Lilly, and Bone Medical, and being listed as an inventor on a U.S. patent application (20050272707) covering methods for preventing or reducing secondary fractures after hip fracture and on another provisional patent application for medication kits and formulations for preventing, treating, or reducing secondary fractures after a previous fracture.

Dr. Colón-Emeric, receiving consulting fees from Novartis, Amgen, and research grants from Novartis, Pfizer, and the Alliance for Better Bone Health.

Dr. Boonen, receiving consulting fees and research support from Novartis.

Dr. Pieper, receiving research support from Novartis.

Dr. Mautalen, receiving consulting and advisory board fees from Novartis.

Dr. Hyldstrup, receiving advisory board fees from Novartis, Eli Lilly, and Nycomed, lecture fees from Merck, Eli Lilly, Nycomed, Novartis, Novo Nordisk, and Servier, and grant support from Eli Lilly, Novartis, Pfizer, Nycomed, Roche, and GlaxoSmithKline.

Dr. Recknor, receiving consulting fees from Procter & Gamble, Roche, and Eli Lilly, lecture fees from Procter & Gamble, Eli Lilly, Roche, GlaxoSmithKline, Merck, and Aventis, and grant support from Procter & Gamble.

Dr. Nordsletten, receiving consulting and advisory board fees from Novartis and DePuy, lecture fees from Wyeth, and grant support from Biomet.

Dr. Bucci-Rechtweg and Dr. Su, being employees of and owning stock in Novartis.

Dr. Eriksen (now an employee of Oslo University, Oslo, Norway), being an employee of Novartis during the design and initiation of the study, and receiving advisory board fees from Novartis, Eli Lilly and Amgen.

Dr. Magaziner, receiving consulting fees from Amgen, Merck, Eli Lilly and Novartis, and grant support from Novartis and Merck.

Ms. Moore, no disclosures.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • J. D. Adachi
    • 1
  • K. W. Lyles
    • 2
  • C. S. Colón-Emeric
    • 2
  • S. Boonen
    • 3
  • C. F. Pieper
    • 2
  • C. Mautalen
    • 4
  • L. Hyldstrup
    • 5
  • C. Recknor
    • 6
  • L. Nordsletten
    • 7
  • K. A. Moore
    • 2
  • C. Bucci-Rechtweg
    • 8
  • G. Su
    • 8
  • E. F. Eriksen
    • 9
  • J. S. Magaziner
    • 10
  1. 1.St. Joseph’s HealthcareMcMaster UniversityHamiltonCanada
  2. 2.Duke University Medical Center and the Geriatrics Research Education and Clinical Center, Veterans Affairs Medical CenterDurhamUSA
  3. 3.University of LeuvenLeuvenBelgium
  4. 4.Centro de Osteopatías MédicasBuenos AiresArgentina
  5. 5.Hvidovre HospitalHvidovreDenmark
  6. 6.United Osteoporosis CentersGainesvilleUSA
  7. 7.Ullevål University HospitalOsloNorway
  8. 8.Novartis Pharmaceuticals CorporationEast HanoverUSA
  9. 9.Oslo University Hospital AkerOsloNorway
  10. 10.University of MarylandBaltimoreUSA

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