Safety of low dose inpatient zoledronic acid in acute hip fracture patients with advanced chronic kidney disease
Authors' conclusion
This study suggests that reduced-dose IP-ZA is likely safe for patients with hip fracture and advanced CKD who are otherwise at high risk for being untreated.
Study context
- Population
- Hip fracture patients with advanced CKD (CrCl < 35 mL/min); predominantly female (77.8%), White (92.4%), mean age 89.9 yr, CrCl 31.1 ± 0.6 mL/minmatched primary cohort
- Participants
- 46 vs 98
- Exposure
- Reduced-dose inpatient zoledronic acid (ZA) vs no anti-osteoporosis medication
- Inpatient ZA (IP-ZA)n = 46
- Controlsn = 98reference
- Outcome
- Safety: daily maximum body temperature, serum creatinine and serum calcium
- Follow-up
- 5 d from the day before IP-ZA (or postoperative day 2 for controls)
Methodological detailspropensity-matched, real-world data, single academic healthcare system, All patients received standing acetaminophen, calcium (650-1000 mg/d) and vitamin D (1000-2500 IU/d) post-surgery
- Propensity-matched
- Real-world data
- Single academic healthcare system
- All patients received standing acetaminophen, calcium (650-1000 mg/d) and vitamin D (1000-2500 IU/d) post-surgery
Main finding
As reported in the abstract
Safety: temperature, serum creatinine, serum calcium · 5 d
- Inpatient-ZA did not affect temperature
- Serum creatinine level remained stable
Observational data: associations, not effects.
Further findings
- Hospital LOS — Hospital LOS similar (IP-ZA vs controls)
- 6.2 ± 0.4 vs 6.5 ± 0.4 d · P = 0.41
30-d readmission
- 30-d readmission rates were similar
Safety
Events
| Outcome | IP-ZA | Controls |
|---|---|---|
| New-onset fever (≥38.0 °C, days 2-4) | 1 | 2 |
Serum calcium · by day 5
- IP-ZA patients with serum calcium <7.5 mg/dL
- 0
- IP-ZA: serum calcium decreased from 8.8 ± 0.1 to 8.2 ± 0.2 mg/dL; unchanged in controls
Original publication
Safety of low dose inpatient zoledronic acid in acute hip fracture patients with advanced chronic kidney disease. J Bone Miner Res. Published 6 January 2026. doi:10.
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