Abstract
Introduction
A quarter of people with hip fractures sustain another fragility fracture within 5 years, but most receive no osteoporosis medication as secondary prevention. To coincide with the publication of ‘A call to action: a five nations consensus on the use of intravenous zoledronate after hip fracture" Age and Ageing, September 2023, we set out to explore clinicians’ reasons for not previously using zoledronate (IV Zol).
Methods
Prior to first presentation of the ‘Call to Action’ at the Global Fragility Fracture Network (FFN) and British Geriatrics Society conferences in autumn 2023, we used conference apps to run an online survey of 156 attendees (99 from UK, and 57 working in other countries).
Results
Licensing of IV Zol excludes people with creatinine clearance (CrCl) <35ml/min. Our surveys found that 27% of UK clinicians (9% of non-UK) already use a 30ml/min CrCl threshold. In addition, 13% (vs. 26%) use eGFR 30ml/min, and 23% (vs. 51%) eGFR 35ml/min as their threshold. This suggests that 63% of UK (87% of non-UK) clinicians already administer IV Zol if CrCl <35ml/min. UK clinicians indicated fewer concerns over reduced effectiveness if IV Zol was given within 14 days of fracture (56% vs. 86%), and greater preparedness to consider 4mg, rather than more expensive 5mg, doses (42% vs. 18%) and single infusions without a subsequent dose (91% vs. 68%).
Conclusions
It is important to understand why people feel reluctant to use IV Zol, despite this being the first-line recommendation of the National Osteoporosis Guideline Group (NOGG).
In particular, our demonstration that many clinicians in the UK and around the world are already using IV Zol, off license, in people with CrCl of 30-35 ml/min will support the ‘Call to Action’ paper, helping many more hip fracture patients with renal function in this category to receive a medication of proven effectiveness.