Hip Fracture

Background

A new treatment pathway for hip fracture has been initiated in NHS Lothian whereby all patients are offered an infusion of zoledronic acid (ZA) when they are an inpatient to reduce the risk of further fractures. Current evidence suggests that the risk of new fractures will be reduced for up to 3 years following a single ZA infusion (see resources).

Primary Care Management

It is recommended that the need for ongoing management of osteoporosis in this predominantly frail, elderly patient group should be evaluated in primary care, three years after the hip fracture. The absolute benefit of treatment in these individuals can be estimated using the ORB calculator.

If, on discussion with the patient and family it is felt clinically appropriate to continue osteoporosis treatment, alendronic acid 70mg once a week should be prescribed. If the patient experiences adverse effects, risedronate 35mg once a week, or liquid buffered alendronate (Binosto) may be used as alternatives. The suggested duration of treatment in these individuals is 10 years.

A combined calcium and vitamin D supplement (Accrete D3, 1000/880) is also indicated in patients with dietary calcium intake <700mg daily. If the patient’s dietary calcium is greater than 700mg daily, then a standalone vitamin D supplement may be considered. There are various choices including cholecalciferol 800 units daily, 5600 units once a week or 25,000 units once every 4 weeks. Dietary calcium intake can be calculated by completion of a simple food frequency questionnaire using a dietary calcium calculator.

M.A & S.R/H.B. 25-01-24