The affect of zoledronic acid on mortality and recovery after surgical fixation of intertrochanteric femur fractures

OBJECTIVE: In our study, we aimed to investigate the effectiveness of zoledronic acid in the treatment of osteoporosis and the effect after intertrochanteric hip fracture surgery. MATERIAL-METHOD: We have observed surgically-treated patients over the age of 65 with the intertrochanteric femoral fractures during one year as randomized prospective. After the measurement of bone mineral density, we have divided our patients into two groups: 56 (49%) patients treated with post-operative 5 mg/year iv zoledronic acid and control group of 58 (51%) patients. Functional results were evaluated with one-year mortality and Harris Hip and Merle d'Aubigne Hip scores. In addition, the difference between the two groups have been categorized and analyzed according to age, sex, side, co-morbid disease, time of surgery, type of anesthesia, the type of surgery, post-operative complications and follow-up periods. Patients with additional diseases that will create more than two co-morbidities were not included in the study. FINDINGS: The average age of the patients were 78,56 (65-93). According to Evans-Jensen classification, 24 patients (% 21,1) were evaluated as Type 2 fracture, 28 patients (% 24,6) as Type 3 fracture, 16 patients (% 14) as Type 4 fracture, and 46 patients (% 40,4) as Type 5 fracture. There were 38 patients (% 33,3) treated by DHS and 76 patients (% 66,7) by PFN.A significant increase was observed in post-operative T scores of the patients receiving zoledronic acid compared to the control group (p <0.001). The mortality rate was %14.3 in Zoledronic acid group and % 34,5 in the control group, significantly higher than zoledronic acid group (p= 0.012). Significantly better functional results were obtained in Zoledronic acid group according to both scoring systems (p=0.025 for the Harris Hip score and p=0.020 for Merle d'Aubigne Hip score). DISCUSSION-RESULTS: The use of zoledronic acid after surgical treatment of intertrochanteric femoral fractures in osteoporotic over 65 year-old patients is a safe treatment modality which reduces mortality, improves functional outcomes and has less side effects with single dose use per year.