Immediate postoperative Zoledronate in older hip fracture patients was not associated with increased risk of acute or subsequent complications, or reoperations: a retrospective observational study

Concerns regarding postoperative complications may delay initiation of anti-osteoporosis treatment after hip fracture. We examined the association between early postoperative Zoledronate administration and acute in-hospital complications, subsequent medical and orthopaedic complications, reoperations, and new fractures within 30 days and one year. In this retrospective observational study, patients aged ≥ 50 years with a new hip fracture were included from two periods: a historical period (HisP) (2012–2013), before implementation of in-patient Zoledronate treatment, and an implementation period (ImpP) (2014–2021), where postoperative Zoledronate was routinely considered. Patients from ImpP not treated with Zoledronate were excluded from comparative analyses. Propensity score matching was used to create comparable treated and untreated groups. Outcomes included acute complications, subsequent medical and orthopaedic complications, reoperations, new fractures, and mortality within 30 days and one year. A total of 1 924 patients were included (68% female, median age 84 years): 529 patients in HisP and 1 395 in ImpP. During ImpP, all patients were assessed for osteoporosis treatment before discharge, and 876 patients (63%) received Zoledronate. Treatment rates remained high among the oldest patients, with 57% aged ≥ 90 years receiving treatment. Following matching and covariate adjustment, the treated patients from ImpP had almost half the odds of acute complications (OR 0.5, 95% CI 0.4–0.6). No differences were observed for medical or orthopaedic 30 days and one-year complications, whereas the odds of new fractures within one year were lower in the treated group (OR 0.5, 95% CI 0.4–0.7). Early postoperative Zoledronate administration was not associated with increased acute complications, 30 days or one-year complications, reoperations or mortality.