Bone Abstracts

Background: Within 5 years, 25% patients presenting with hip fracture will break another bone. Intravenous (IV) zoledronic acid reduces this risk by one third and is recommended first-line treatment for bone protection following hip fracture. In September 2024 only 15% of hip fracture patients received IV zoledronic acid during admission. One barrier to administration was the absence of a rapid load vitamin D protocol. A rapid vitamin D load policy was implemented alongside guidance promoting IV Zoledronic acid as first-line therapy post hip fracture. This project aimed to assess compliance with the new trust guidelines and improve prescribing of IV zoledronic acid in this cohort.

Methods: Medical records of all patients presenting with a hip fracture in September 2025 were reviewed. Data collected included vitamin D and IV zoledronic acid prescribing practices, reasons for non-prescription, and whether a follow-up plan was communicated to the GP.

Results: At presentation, 50% of patients were vitamin D deficient, and 89% received the rapid loading regimen. Overall, 65% of patients were prescribed zoledronic acid prior to discharge. The main barrier to prescribing was awaiting dual-energy X-ray absorptiometry (DEXA) scan (29%). A follow-up plan was not communicated in the patients discharge letter in 40% of cases.

Conclusion: Prescribing of IV zoledronic acid after hip fracture has improved and is now established as first-line secondary prevention within the hospital. Consistency in practice is needed, emphasising timely intervention and avoiding delays for bone density imaging. Further work is required to improve communication of follow-up plans upon discharge.