Overcoming a Treatment Barrier – Setting Up a Home-Based Osteoporosis Treatment with Zoledronate (HOTZ) Service

Abstract Background Intravenous Zoledronic acid is an effective, once-annual treatment for osteoporosis and is indicated following hip fracture in particular, in addition to other osteoporotic fracture types. One of the barriers to its administration (as described in a survey of Geriatricians attending the FFN, BGS and IGS meetings in 2023), is a lack of facility to arrange subsequent doses because intravenous infusions are traditionally, exclusively hospital-based. Methods The Beaumont Hospital Fracture Liaison Service (FLS) collaborated with our local Community Intervention Team (CIT) to establish a protocol for home-based Zoledronic acid infusions. Following an initial Zoledronate dose being given in the inpatient or outpatient setting, a virtual clinic is conducted 11 months later to plan subsequent doses, as is standard practice in our unit. At these clinics, we identified those who are housebound with no means of travelling to hospital clinics as potentially eligible for the HOTZ service. Following home-based blood tests, a customised Zoledronic acid checklist addresses patient information, biochemical parameters, required infusion duration and includes a safety checklist for any rare adverse events since previous infusion. Education and training was provided by the FLS and the CIT lead to the CIT nursing staff responsible for administering the infusions. Results We have had four patients to date receive the HOTZ service with several further planned. No adverse events reported. The feedback from all was extremely positive, some stating that they felt everyone should have this service, and they were glad of the cost savings on taxis and avoiding the strain on family members or carers of escorting them to hospital appointments for blood tests and again for treatment. Conclusion Setting up a Home-based Osteoporosis Treatment Service is feasible and preliminary results show very high user-satisfaction with the service. We recommend that FLS & CIT nationally consider roll out of such services.