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Site-specific differential effects of once-yearly zoledronic acid on the hip assessed with quantitative computed tomography: results from the HORIZON Pivotal Fracture Trial

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Abstract

Summary

We used new approaches to the analysis of diagnostic scans to detect changes in bone density in different regions of the hip after 3 years of treatment with the zoledronic acid. We showed that the drug significantly increases hip bone density compared to placebo at regions where hip fractures usually occur.

Introduction

This study aims to identify whether treatment with zoledronic acid exerts site-specific differential effects on volumetric bone mineral density (vBMD) at the hip.

Methods

We analysed quantitative computed tomography scans of the hip obtained at baseline and 36 months in 179 women participating in the HORIZON Pivotal Fracture Trial. Cortical, trabecular and integral BMDs were determined at three main regions of interest—the femoral neck (FN), trochanter (TR) and total hip (TH)—and several sub-regions of interest, namely the proximal, middle, distal, anterior, posterior, inferomedial and superolateral FN, and the middle and distal TR.

Results

Volumetric BMD increased significantly (p < 0.05) from baseline with zoledronic acid compared to placebo. Trabecular vBMD increased as follows: FN, 5.4 %; FN sub-regions, 6.0 % (proximal), 4.4 % (middle), 5.6 % (distal), 7.5 % (anterior), 7.0 % (superolateral) and 5.4 % (posterior); TR, 6.5 % and TH, 5.7 %. Cortical vBMD increased as follows: FN sub-regions, 5.0 % (proximal FN) and 2.3 % (anterior); TR, 4.6 %; middle TR, 2.7 % and TH, 3.8 %.

Conclusions

The effects on vBMD of annual infusion of 5 mg of zoledronic acid are site-specific and dominated by trabecular changes.

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Acknowledgments

We would like to thank our sponsors, the Medical Research Council and the National Institute for Health Research (NIHR). The HORIZON PFT was sponsored by Novartis Pharma AG, Basel, Switzerland. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Acknowledgements go to the editorial board of the Sheffield NIHR Bone Biomedical Research Unit for their help in preparing this manuscript.

Conflicts of interest

Dr. Eastell serves as a consultant, has received honoraria for speaking, and has received grant funding from Novartis, Amgen, Sanofi-Aventis, Lilly, Organon, Pfizer, and Procter & Gamble Pharmaceuticals. Dr. Black serves as a consultant for Nycomed and Zosano and has research contracts with Novartis and Roche. Other authors have no conflict of interest.

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Authors and Affiliations

  1. Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, S10 2RX, UK

    L. Yang, A. V. Sycheva & R. Eastell

  2. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

    D. M. Black

  3. School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield, S10 2RX, UK

    L. Yang

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  1. L. Yang
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  2. A. V. Sycheva
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  3. D. M. Black
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  4. R. Eastell
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Correspondence to L. Yang.

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Yang, L., Sycheva, A.V., Black, D.M. et al. Site-specific differential effects of once-yearly zoledronic acid on the hip assessed with quantitative computed tomography: results from the HORIZON Pivotal Fracture Trial. Osteoporos Int 24, 329–338 (2013). https://doi.org/10.1007/s00198-012-2200-x

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