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The impact of acute-phase reaction on mortality and re-fracture after zoledronic acid in hospitalized elderly osteoporotic fracture patients

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Abstract

Summary

This study involving 674 elderly osteoporotic fracture (OPF) patients undergoing orthopedic surgery investigated the long-term outcomes of acute phase reaction (APR) after initial zoledronic acid (ZOL). Those who had an APR had a 97% higher risk of mortality and a 73% lower rate of re-fracture than patients who did not.

Introduction

Annual infusion of ZOL efficiently decreases the risk of fracture. A temporary APR, consisting of flu-like symptoms, myalgia, and fever, is frequently observed within 3 days after the first dose. This work aimed to identify whether the occurrence of APR after initial ZOL infusion is a reliable indicator of drug efficacy for mortality and re-fracture in elderly OPF patients undergoing orthopedic surgery.

Methods

This retrospectively observed work was constructed on a database prospectively collected from the Osteoporotic Fracture Registry System of a tertiary level A hospital in China. Six hundred seventy-four patients 50 years old or older with newly identified hip/morphological vertebral OPF who received ZOL for the first time after orthopedic surgery were included in the final analysis. APR was identified as a maximum axillary body temperature greater than 37.3 °C for the first 3 days after ZOL infusion. We utilized models of multivariate Cox proportional hazards to compare the risk of all-cause mortality in OPF patients with APR (APR+) and without APR (APR-). Competing risks regression analysis was used to examine the association between the occurrence of APR and re-fracture when mortality was taken into account.

Results

In a fully adjusted Cox proportional hazards model, APR+ patients had a significantly higher risk of death than APR- patients with a hazard ratio [HR] 1.97 (95% CI, 1.09–3.56; P-value = 0.02). Furthermore, in an adjusted competing risk regression analysis, APR+ patients had a significantly reduced risk of re-fracture compared with APR- patients with a sub-distribution HR, 0.27 (95% CI, 0.11–0.70; P-value = 0.007).

Conclusions

Our findings suggested a potential association between the occurrence of APR and increased mortality risk. An initial dose of ZOL following orthopedic surgery was found to be protective against re-fracture in older patients with OPFs.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

The study was supported by China Postdoctoral Science Foundation (CN) (2022M711439), Elderly Health Research Project of Jiangsu Province (CN) (LKZ2022020), Suzhou Collaborative Innovation Research Project of Medical and Industrial Integration (CN) (SLJ2022023), Open Project of Jiangsu Provincial Key Laboratory of Geriatric Disease Prevention and Transformation (CN) (KJS2222), and Suzhou Key Clinical Diagnosis and Treatment Technology Project (CN) (LCZX202024).

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Authors and Affiliations

  1. Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, 215300, Jiangsu, China

    K. Lu, Y.-m. Wu & C. Li

  2. Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute of Soochow University, Suzhou, Jiangsu, China

    Q. Shi

  3. Information Department, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China

    Y.-q. Gong

  4. Chronic Disease Department, Kunshan Center For Disease Control and Prevention, Suzhou, Jiangsu, China

    T. Zhang

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  1. K. Lu
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Correspondence to C. Li.

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We received ethical approval from the Affiliated Kunshan Hospital of Jiangsu University (approval No. 2020-03-046-K01) and was compliant with the Declaration of Helsinki. Patient identification data were hidden from the researchers analyzing the data. Written informed consent was not required because of the investigation’s observational and anonymous design.

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Lu, K., Wu, Ym., Shi, Q. et al. The impact of acute-phase reaction on mortality and re-fracture after zoledronic acid in hospitalized elderly osteoporotic fracture patients. Osteoporos Int 34, 1613–1623 (2023). https://doi.org/10.1007/s00198-023-06803-w

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