Zoledronic acid results in better health-related quality of life following hip fracture: the HORIZON–Recurrent Fracture Trial

Summary This study evaluated the benefits of ZOL versus placebo on health-related quality of life (HRQoL) among patients from HORIZON–RFT. At month 24 and end of the study visit, ZOL significantly improved patients’ overall health state compared to placebo as assessed by the EQ-5D VAS. Introduction To evaluate the benefits of zoledronic acid (ZOL) versus placebo on health-related quality of life (HRQoL) among patients from The Health Outcomes and Reduced Incidence With Zoledronic Acid Once Yearly Recurrent Fracture Trial (HORIZON–RFT). Methods In this randomized, double-blind, placebocontrolled trial, 2,127 patients were randomized to receive annual infusion of ZOL 5 mg (n=1,065) or placebo (n= 1,062) within 90 days after surgical repair of low-trauma hip fracture. HRQoL was measured using EQ-5D Visual Analogue Scale (VAS) and utility scores (EuroQol instrument) at months 6, 12, 24, 36, and end of the study visit. Analysis of covariance model included baseline EQ-5D value, region, and treatment as explanatory variables. Results At baseline, patients (mean age 75 years; 24% men and 76% women) were well matched between treatment groups with mean EQ-5D VAS of 65.82 in ZOL and 65.70 in placebo group. At the end of the study, mean change from baseline in EQ-5D VAS was greater for ZOL vs. placebo in all patients (7.67±0.56 vs. 5.42±0.56), and in subgroups of patients experiencing clinical vertebral frac- tures (8.86±4.91 vs. −1.69±3.42), non-vertebral fractures (5.03±2.48 vs. −1.07±2.16), and clinical fractures (5.19± 2.25 vs. −0.72±1.82) with treatment difference significantly in favor of ZOL. EQ-5D utility scores were comparable for ZOL and placebo groups, but more patients on placebo consistently had extreme difficulty in mobility (1.74% for ZOL vs. 2.13% for placebo; p=0.6238), self-care (4.92% vs. 6.69%; p=0.1013), and usual activities (10.28% vs. 12.91%; p=0.0775). Conclusion ZOL significantly improves HRQoL in patients with low-trauma hip fracture.