Exploring Barriers to Timely Administration of Intravenous Zoledronic Acid following Hip Fracture

Abstract Background In the Age & Ageing paper “Call to action: A five nations consensus on the use of intravenous zoledronate after hip fracture” 2023, the authors addressed key reasons that might underpin orthogeriatricians’ reluctance to offer intravenous zoledronate (IV Zol) while patients were still in hospital after a hip fracture. Methods The paper was presented at the Global Congress of the Fragility Fracture Network (FFN), October 2023, the Orthogeriatrics day of the British Geriatrics Society (BGS) Autumn conference 2023 and the Bone Health Special interest group meeting at the Irish Gerontological Society (IGS) 2023. At the start of each meeting, a survey of attendees was carried out on their attitudes to, and current use of IV Zol following hip fracture. Here we present results IGS survey results. Results N=37 responded, 85% were concerned that early administration of IV Zol might impair its effectiveness, similarly to FFN and BGS respondents but 42% said they would not administer IV Zol within 14 days of a hip fracture vs. 29% of FFN, 24% of BGS respondents. Forty-two percent also said they would not give vitamin D loading without blood levels vs. 24% of FFN, 24% of BGS respondents and 29% acknowledged that laboratory waiting times for Vitamin D frequently delay IV Zol. There were 8% using a CrCl threshold of 30ml/min, 35% using eGFR threshold of 30ml/min and 41% an eGFR of 35mls/min. eGFR overestimates CrCl, suggesting that the vast majority of clinicians already use IV Zol at below licenced CrCl threshold of 35ml/min. Conclusion Following hip fracture, IV Zol appears widely-used used in those with CrCl of 30-35ml/min, in line with threshold in the original clinical trial. We identified a number of factors impeding early administration however, one being the perceived need for vitamin D results beforehand. Education around its safe use will enable more patients to benefit.