Shanghai Jiaotong Daxue xuebao. Yixue ban (Jul 2024)
Effect of early postoperative administration of zoledronic acid on the prognosis of osteoporotic femoral intertrochanteric fracture in patients with advanced ages
Abstract
Objective·To investigate the effect of early postoperative administration of zoledronic acid on fracture healing and functional recovery in elderly patients with osteoporotic femoral intertrochanteric fracture treated with proximal femoral nail antirotation (PFNA) surgery, and explore other potential prognostic factors.Methods·A total of 174 patients with femoral intertrochanteric fractures of 80 years old or above who underwent PFNA treatment in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January, 2016 to February, 2022, were divided into experimental group (n=26) and control group (n=148) according to whether they received zoledronic acid early after surgery. All patients were followed up twice at 6 weeks and 12 weeks after surgery. The patients in the experimental group were matched with the control group by propensity score matching (PSM) at a ratio of 1:3 (the matching factors included age, gender, fracture type, and body mass index). General characteristics, as well as fracture healing and functional recovery at the two follow-up visits were compared between the two groups after matching. Subsequently, Logistic regression was used to explore the potential prognostic factors on fracture healing at 12 weeks after surgery.Results·PSM resulted in 25 patients in the experimental group and 65 patients in the control group, and there were no statistically significant differences in baseline characteristics between the two groups. The fracture healing rates at 6 weeks and 12 weeks after surgery in the experimental group (16.0% and 96.0%, respectively) were higher than those in the control group (1.5% and 73.8%), and the differences were statistically significant (P<0.05). Harris hip function score in the experimental group at 12 weeks was significantly higher than that of the control group (P=0.019). The results of Logistic regression analysis showed that good surgical reduction (OR=12.52, 95%CI 2.67‒58.74, P=0.001), early postoperative administration of zoledronic acid (OR=10.14, 95%CI 1.01‒102.09, P=0.049), and higher serum albumin level (OR=1.15, 95%CI 1.02‒1.29, P=0.025) were the favorable factors of early fracture healing, while unstable fracture (OR=0.10, 95%CI 0.03‒0.31, P=0.000) was the unfavorable factor.Conclusion·For elderly patients with osteoporotic intertrochanteric femoral fractures treated with PFNA surgery, early postoperative administration of zoledronic acid can promote fracture healing and lead to better functional recovery; in addition, good surgical reduction and higher serum albumin levels are favorable factors for fracture healing, whereas unstable fracture presents as a hindrance to the healing process.
Keywords
